MEDICARE: TWO RIVERS WELLNESS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101Y00000X	Counselor
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner
3	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013543347
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TWO RIVERS WELLNESS

Provider Business Mailing Address
First Line	:	1552 CARTERSVILLE RD
Second Line	:
City	:	ROSEBUD
State	:	MT
Zip	:	59347-9522
Country	:	US
Telephone Number	:	406-351-2196
Fax Number	:	406-234-2928

Provider Business Practice Location Address
First Line	:	2911 WILSON ST
Second Line	:
City	:	MILES CITY
State	:	MT
Zip	:	59301-5722
Country	:	US
Telephone Number	:	406-234-2929
Fax Number	:	406-234-2928

Authorized Official
Title or Position	:	FNP-C, PMHNP-BC
Name	:	LAURA L. WETHERELT
Credential	:	APRN
Telephone Number	:	406-234-2929

Provider Enumeration Date	:	03/18/2020
Last Update Date	:	05/27/2021

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