Provider Demographics
NPI:1336583608
Name:CHOICES , ALCOHOL, DRUG & BEHAVIORAL HELP CENTER INC.
Entity Type:Organization
Organization Name:CHOICES , ALCOHOL, DRUG & BEHAVIORAL HELP CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:HANSEN
Authorized Official - Last Name:BOAL
Authorized Official - Suffix:
Authorized Official - Credentials:BSW NCACII LAT
Authorized Official - Phone:307-783-1088
Mailing Address - Street 1:77 COUNTY ROAD 109
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:WY
Mailing Address - Zip Code:82930-9797
Mailing Address - Country:US
Mailing Address - Phone:307-783-1088
Mailing Address - Fax:307-783-1028
Practice Address - Street 1:77 COUNTY ROAD 109
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:WY
Practice Address - Zip Code:82930-9797
Practice Address - Country:US
Practice Address - Phone:307-783-1088
Practice Address - Fax:307-783-1028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-17
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
WYLAT-199324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty