Provider Demographics
NPI:1144373440
Name:BIG HORN BASIN COUNSELING SERVICES
Entity type:Organization
Organization Name:BIG HORN BASIN COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:AUTUMN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SNYDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-548-6543
Mailing Address - Street 1:1114 LANE 12
Mailing Address - Street 2:
Mailing Address - City:LOVELL
Mailing Address - State:WY
Mailing Address - Zip Code:82431-9555
Mailing Address - Country:US
Mailing Address - Phone:307-548-6543
Mailing Address - Fax:307-548-6565
Practice Address - Street 1:116 SOUTH 3RD
Practice Address - Street 2:
Practice Address - City:BASIN
Practice Address - State:WY
Practice Address - Zip Code:82410
Practice Address - Country:US
Practice Address - Phone:307-568-2020
Practice Address - Fax:307-568-2503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY106515702Medicaid
WY106515705Medicaid
WY106515706Medicaid
WY106515703Medicaid
WY106515700Medicaid
WY106515701Medicaid