MEDICARE: WESTERN MONTANA MENTAL HEALTH CENTER

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320800000X	Mental Illness Community Based Residential Treatment Facility	11813	MT

General Provider Information

NPI Number	:	1528363793
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WESTERN MONTANA MENTAL HEALTH CENTER

Provider Business Mailing Address
First Line	:	140 N RUSSELL ST
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59801-1704
Country	:	US
Telephone Number	:	406-532-8400
Fax Number	:	406-224-4402

Provider Business Practice Location Address
First Line	:	1404 WESTWOOD DR
Second Line	:
City	:	HAMILTON
State	:	MT
Zip	:	59840-2315
Country	:	US
Telephone Number	:	406-532-9101
Fax Number	:	406-363-4498

Authorized Official
Title or Position	:	CEO
Name	:	JODI DALY
Credential	:	LCPC
Telephone Number	:	406-532-8400

Provider Enumeration Date	:	01/20/2011
Last Update Date	:	01/25/2018

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