Healthcare Provider Details

I. General information

NPI: 1336992932
Provider Name (Legal Business Name): RUGGED TERRAIN MENTAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2024
Last Update Date: 07/16/2024
Certification Date: 07/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 E WASHINGTON ST STE C
KALISPELL MT
59901-3967
US

IV. Provider business mailing address

30 E WASHINGTON ST STE C
KALISPELL MT
59901-3967
US

V. Phone/Fax

Practice location:
  • Phone: 406-200-8148
  • Fax:
Mailing address:
  • Phone: 406-200-8148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: HILARY PATTERSON
Title or Position: THERAPIST
Credential: LCSW
Phone: 406-200-8148