1881973816 NPI number — WESTERN MONTANA MENTAL HEALTH CENTER

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881973816 NPI number — WESTERN MONTANA MENTAL HEALTH CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WESTERN MONTANA MENTAL HEALTH CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1881973816
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/25/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
140 N RUSSELL ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MISSOULA
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59801-1704
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-532-8400
Provider Business Mailing Address Fax Number:
406-224-4402

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1273 DAKOTA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MISSOULA
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59801-1709
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-542-1411
Provider Business Practice Location Address Fax Number:
406-543-2631
Provider Enumeration Date:
08/09/2011

Additional Information

Authorized Official

Authorized Official Last Name:
DALY
Authorized Official First Name:
JODI
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
406-532-8400

Provider Taxonomy Codes

  • Taxonomy code: 320800000X , with the licence number:  11813 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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