MEDICARE: THERAPEUTIC MENTORING

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	1041C0700X	Clinical Social Worker	872	MT
2	1041C0700X	Clinical Social Worker	860	MT

General Provider Information

NPI Number	:	1942650601
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THERAPEUTIC MENTORING

Provider Business Mailing Address
First Line	:	PO BOX 676
Second Line	:
City	:	HAMILTON
State	:	MT
Zip	:	59840-0676
Country	:	US
Telephone Number	:	406-531-8846
Fax Number	:

Provider Business Practice Location Address
First Line	:	140 CHERRY ST
Second Line	:	STE 202
City	:	HAMILTON
State	:	MT
Zip	:	59840-3517
Country	:	US
Telephone Number	:	406-531-8846
Fax Number	:

Authorized Official
Title or Position	:	MENTAL HEALTH THERAPIST
Name	:	MR. THADDEUS J WIDMER
Credential	:	LCSW
Telephone Number	:	406-531-8846

Provider Enumeration Date	:	06/14/2016
Last Update Date	:	06/14/2016

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Directions to “THERAPEUTIC MENTORING ” Practice Location

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