Basic Information
| Provider Information | |||||||||
| NPI: | 1538826946 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHAMBURG | ||||||||
| FirstName: | REBEKAH | ||||||||
| MiddleName: | S | ||||||||
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| Mailing Information | |||||||||
| Address1: | HIGH COUNTRY BEHAVIORAL HEALTH | ||||||||
| Address2: | 1841 MADORA AVE | ||||||||
| City: | DOUGLAS | ||||||||
| State: | WY | ||||||||
| PostalCode: | 82633 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3073582846 | ||||||||
| FaxNumber: | 3073581144 | ||||||||
| Practice Location | |||||||||
| Address1: | HIGH COUNTRY BEHAVIORAL HEALTH | ||||||||
| Address2: | 1841 MADORA AVE | ||||||||
| City: | DOUGLAS | ||||||||
| State: | WY | ||||||||
| PostalCode: | 82633 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3073582846 | ||||||||
| FaxNumber: | 3073581144 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/19/2021 | ||||||||
| LastUpdateDate: | 11/19/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 172V00000X | Y | Other Service Providers | Community Health Worker |
No ID Information.