Healthcare Provider Details

I. General information

NPI: 1114894821
Provider Name (Legal Business Name): INNERTHREAD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2025
Last Update Date: 10/20/2025
Certification Date: 10/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 MAIN ST
WOLF POINT MT
59201-1534
US

IV. Provider business mailing address

283 MENDENHALL RD
WOLF POINT MT
59201-7128
US

V. Phone/Fax

Practice location:
  • Phone: 406-688-9740
  • Fax:
Mailing address:
  • Phone: 406-688-9740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name: CORDIE M LICCIARDI
Title or Position: MANAGER/ CREDENTIAL SPECIALIST
Credential:
Phone: 701-580-4091