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General NPI Number Information
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NPI Number | 1437529021
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Entity Type | Organization
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Legal Business Name | WESTERN MONTANA MENTAL HEALTH CENTER
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Dates
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Enumeration Date | 09/25/2015
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Last Update Date | 08/29/2019
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Provider Practice Location Address
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Address Line | 1321 WYOMING ST
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City | MISSOULA
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State | MT
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Zip | 59801-1725
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Country | US
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Telephone | 406-532-8400
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Fax | 406-224-4402
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Provider Business Mailing Address
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Address Line | 1321 WYOMING ST
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City | MISSOULA
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State | MT
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Zip | 59801-1725
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Country | US
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Telephone | 406-532-8400
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Fax | 406-224-4402
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Authorized Official
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Title or Position | CEO
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Name | LEVI ANDERSON
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Credential | FACHE
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Telephone | 406-532-8400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 13459
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License Number State | MT
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 12652
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License Number State | MT
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Taxonomy #3
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 12652
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License Number State | MT
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Taxonomy #4
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number | 12652
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License Number State | MT
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Taxonomy #5
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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 | 13459
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License Number State | MT
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Taxonomy #6
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Taxonomy Code | 323P00000X
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Taxonomy Name | Psychiatric Residential Treatment Facility
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License Number | 12652
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License Number State | MT
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Taxonomy #7
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 12652
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License Number State | MT
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