Provider Demographics
NPI:1447438379
Name:HIGH COUNTRY PSYCHIATRIC SERVICES, PA
Entity type:Organization
Organization Name:HIGH COUNTRY PSYCHIATRIC SERVICES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:
Authorized Official - Last Name:ATWELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:828-265-4370
Mailing Address - Street 1:PO BOX 3559
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-0859
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:152 SOUTHGATE DR
Practice Address - Street 2:SUITE 3A
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-4959
Practice Address - Country:US
Practice Address - Phone:828-265-4370
Practice Address - Fax:828-265-4354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-01
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC28609261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health