Provider Demographics
NPI:1407245756
Name:YELLOWSTONE BOYS AND GIRLS RANCH
Entity Type:Organization
Organization Name:YELLOWSTONE BOYS AND GIRLS RANCH
Other - Org Name:YBGR
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAVERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-655-2109
Mailing Address - Street 1:3212 1ST AVE S
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59101-3814
Mailing Address - Country:US
Mailing Address - Phone:406-651-3122
Mailing Address - Fax:
Practice Address - Street 1:3212 1ST AVE S
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-3814
Practice Address - Country:US
Practice Address - Phone:406-651-3122
Practice Address - Fax:406-651-2783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-09
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTSWP-LCPC-LIC-11057251S00000X
MTSWP-LCPC-LIC-8348251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health