Healthcare Provider Details

I. General information

NPI: 1912032509
Provider Name (Legal Business Name): EASTERN MT COMMUNITY MENTAL HEALTH CDU PROG
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 10/23/2024
Certification Date: 10/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2508 WILSON ST
MILES CITY MT
59301-5000
US

IV. Provider business mailing address

2508 WILSON ST
MILES CITY MT
59301-5000
US

V. Phone/Fax

Practice location:
  • Phone: 406-234-0234
  • Fax:
Mailing address:
  • Phone: 406-234-0234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number273-07
License Number StateMT

VIII. Authorized Official

Name: KATHY BEASON
Title or Position: CIO
Credential:
Phone: 406-234-0234