Provider Demographics
NPI:1245818186
Name:PARK COUNTY COURT SUPERVISED TREATMENT PROGRAM
Entity type:Organization
Organization Name:PARK COUNTY COURT SUPERVISED TREATMENT PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:VOTAW
Authorized Official - Suffix:
Authorized Official - Credentials:MJA
Authorized Official - Phone:307-527-1801
Mailing Address - Street 1:PO BOX 906
Mailing Address - Street 2:
Mailing Address - City:CODY
Mailing Address - State:WY
Mailing Address - Zip Code:82414-0906
Mailing Address - Country:US
Mailing Address - Phone:307-527-1800
Mailing Address - Fax:307-527-1806
Practice Address - Street 1:1501 STAMPEDE AVE STE 2058
Practice Address - Street 2:
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414-4728
Practice Address - Country:US
Practice Address - Phone:307-527-1800
Practice Address - Fax:307-527-1806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-31
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder