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NPI Code Detail

MEDICARE: WAKE MENTAL HEALTH LLC

MEDICARE: WAKE MENTAL HEALTH LLC
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
11041C0700XClinical Social Worker

General Provider Information

NPI Number : 1700473253
Entity Type Code : Organization
Provider Name (Legal Business Name) : WAKE MENTAL HEALTH LLC
Provider Business Mailing Address
First Line : PO BOX 3206
Second Line :
City : KALISPELL
State : MT
Zip : 59903-3206
Country : US
Telephone Number : 406-253-1807
Fax Number :
Provider Business Practice Location Address
First Line : 1077 WHITEFISH STAGE ROAD
Second Line :
City : KALISPELL
State : MT
Zip : 59901-2735
Country : US
Telephone Number : 406-253-1807
Fax Number :
Authorized Official
Title or Position : LCSW
Name : JILL DIESER
Credential :
Telephone Number : 406-253-1807
Provider Enumeration Date : 12/30/2020
Last Update Date : 09/18/2025

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Directions to “WAKE MENTAL HEALTH LLC ” Practice Location

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