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General NPI Number Information
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NPI Number | 1003764911
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Entity Type | Organization
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Legal Business Name | MISSION MOUNTAIN RECOVERY AND WELLNESS LLC
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Dates
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Enumeration Date | 03/17/2026
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Last Update Date | 03/17/2026
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Provider Practice Location Address
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Address Line | 15 3RD AVE E
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City | POLSON
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State | MT
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Zip | 59860-2113
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Country | US
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Telephone | 406-319-2082
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Fax |
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Provider Business Mailing Address
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Address Line | 1311 7TH ST E
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City | POLSON
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State | MT
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Zip | 59860-4240
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Country | US
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Telephone | 406-293-0783
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Fax |
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Authorized Official
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Title or Position | CO/OWNER- DIRECTOR OF OPERATIONS
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Name | ROSE SMITH
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Credential |
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Telephone | 406-293-0783
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TP2701X
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Taxonomy Name | Group Psychotherapy Psychologist
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License Number |
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License Number State |
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