MEDICARE: WATSON CHILDREN'S SHELTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0855X	Adolescent and Children Mental Health Clinic/Center

General Provider Information

NPI Number	:	1306776083
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WATSON CHILDREN'S SHELTER

Provider Business Mailing Address
First Line	:	4978 BUCKHOUSE LN
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59804-9504
Country	:	US
Telephone Number	:	406-549-0058
Fax Number	:

Provider Business Practice Location Address
First Line	:	4978 BUCKHOUSE LN
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59804-9504
Country	:	US
Telephone Number	:	406-549-0058
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	ERIN STACY HOUGE
Credential	:	LCSW
Telephone Number	:	406-549-0058

Provider Enumeration Date	:	05/22/2026
Last Update Date	:	05/22/2026

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