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General NPI Number Information
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NPI Number | 1588216535
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Entity Type | Organization
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Legal Business Name | DIVERSIFIED THERAPEUTIC SERVICES, PLLC
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Dates
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Enumeration Date | 07/10/2019
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Last Update Date | 07/10/2019
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Provider Practice Location Address
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Address Line | 30 E WASHINTON ST, SUITE A
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City | KALISPELL
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State | MT
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Zip | 59901
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Country | US
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Telephone | 406-471-4296
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Fax |
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Provider Business Mailing Address
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Address Line | 175 HUTTON RANCH RD STE 103
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City | KALISPELL
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State | MT
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Zip | 59901-2142
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Country | US
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Telephone | 406-471-4296
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Fax |
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Authorized Official
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Title or Position | MSW THERAPIST
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Name | JACKSON HOKANSON
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Credential | SWLC
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Telephone | 406-290-9039
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 |
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License Number State |
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