Healthcare Provider Details

I. General information

NPI: 1861729535
Provider Name (Legal Business Name): 3 RIVERS MENTAL HEALTH SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2009
Last Update Date: 02/19/2025
Certification Date: 02/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 REGENT ST STE A
MISSOULA MT
59801-5665
US

IV. Provider business mailing address

1620 REGENT ST STE A
MISSOULA MT
59801-5665
US

V. Phone/Fax

Practice location:
  • Phone: 406-830-3294
  • Fax:
Mailing address:
  • Phone: 406-830-3294
  • Fax: 406-258-0367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number12127
License Number StateMT
# 4
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number12754
License Number StateMT

VIII. Authorized Official

Name: TAE HARTLESS
Title or Position: MANAGER
Credential:
Phone: 406-830-3294