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General NPI Number Information
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NPI Number | 1316525603
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Entity Type | Organization
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Legal Business Name | CROSSWINDS RECOVERY
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Dates
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Enumeration Date | 03/30/2021
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Last Update Date | 06/02/2025
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Provider Practice Location Address
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Address Line | 2001 S RUSSELL ST
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City | MISSOULA
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State | MT
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Zip | 59801-6621
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Country | US
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Telephone | 406-830-4167
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 5102
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City | MISSOULA
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State | MT
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Zip | 59806-5102
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Country | US
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Telephone | 406-544-4510
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | STEPHEN RANDALL FERGUSON
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Credential | LCSW, LAC
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Telephone | 406-544-4510
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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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 | 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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