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General NPI Number Information
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NPI Number | 1013543347
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Entity Type | Organization
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Legal Business Name | TWO RIVERS WELLNESS
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Dates
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Enumeration Date | 03/18/2020
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Last Update Date | 05/27/2021
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Provider Practice Location Address
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Address Line | 2911 WILSON ST
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City | MILES CITY
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State | MT
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Zip | 59301-5722
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Country | US
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Telephone | 406-234-2929
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Fax | 406-234-2928
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Provider Business Mailing Address
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Address Line | 1552 CARTERSVILLE RD
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City | ROSEBUD
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State | MT
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Zip | 59347-9522
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Country | US
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Telephone | 406-351-2196
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Fax | 406-234-2928
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Authorized Official
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Title or Position | FNP-C, PMHNP-BC
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Name | LAURA L. WETHERELT
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Credential | APRN
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Telephone | 406-234-2929
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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