MENTAL HEALTH & RECOVERY SERVICES OF JACKSON HOLE NPI 1578635462

NPI Information

NPI: 1578635462
Provider Name: MENTAL HEALTH & RECOVERY SERVICES OF JACKSON HOLE

Doing Business As: JACKSON HOLE COMMUNITY COUNSELING CENTER

Classification: Clinic/Center - 261QM0801X
Entity Type: Organization

Specialization: Mental Health (Including Community Mental Health Center)

Address:
640 E BROADWAY AVE
JACKSON, WY
ZIP 83001
Phone: (307) 733-2046
Get Directions

MENTAL HEALTH & RECOVERY SERVICES OF JACKSON HOLE is a mental health (including community mental health center) clinic center in Jackson, WY. MENTAL HEALTH & RECOVERY SERVICES OF JACKSON HOLE NPI is 1578635462. The provider is registered as an organization entity type.
The provider Is Doing Business As Jackson Hole Community Counseling Center.

The provider's business location address is:

640 E BROADWAY AVE
JACKSON, WY
ZIP 83001
Phone: (307) 733-2046
Fax: (307) 733-6289

The provider's authorized official is Deidre Ashley .
The authorized official title is Executive Director and has the following contact phone number (307) 733-2046.

The enumeration date for this NPI number is 11/15/2006 and was last updated on 7/19/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	Primary
1	251C00000X	Day Training, Developmentally Disabled Services		No
2	261QR0405X	Clinic/Center	Rehabilitation, Substance Use Disorder	No
3	261QM0801X	Clinic/Center	Mental Health (Including Community Mental Health Center)	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	00708001	OTHER	WYOMING	BLUSE CROSS BLUE SHIELD
2	106872504	MEDICAID	WYOMING
3	106872503	MEDICAID	WASHINGTON
4	106872500	MEDICAID	WYOMING

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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