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General NPI Number Information
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NPI Number | 1760201982
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Entity Type | Organization
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Legal Business Name | WELLNESS RECOVERY GROUP PLLC
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Dates
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Enumeration Date | 10/04/2024
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Last Update Date | 10/04/2024
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Provider Practice Location Address
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Address Line | 3425 SGT SANDERS ST
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City | MISSOULA
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State | MT
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Zip | 59804-7224
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Country | US
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Telephone | 406-540-2846
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1737
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City | MISSOULA
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State | MT
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Zip | 59806-1737
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Country | US
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Telephone | 406-540-2846
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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 | MRS. ANDREA JOAN FORAN
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Credential | LMFT, LCPC, LAC
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Telephone | 406-540-2846
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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