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1992786784

NPI Code Detail

MEDICARE: EASTERN MONTANA COMMUNITY MENTAL HEALTH CENTER

MEDICARE: EASTERN MONTANA COMMUNITY 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	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	101YM0800X	Mental Health Counselor
3	1041C0700X	Clinical Social Worker
4	251B00000X	Case Management Agency
5	251S00000X	Community/Behavioral Health Agency
6	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)	10392	MT
7	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center
8	320800000X	Mental Illness Community Based Residential Treatment Facility
9	363LP0808X	Psychiatric/Mental Health Nurse Practitioner
10	261Q00000X	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	75031	OTHER	MT	BS/BS PROVIDER #
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1992786784
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EASTERN MONTANA COMMUNITY MENTAL HEALTH CENTER

Provider Business Mailing Address
First Line	:	PO BOX 1530
Second Line	:
City	:	MILES CITY
State	:	MT
Zip	:	59301-1530
Country	:	US
Telephone Number	:	406-234-0234
Fax Number	:	406-234-0235

Provider Business Practice Location Address
First Line	:	2508 WILSON ST
Second Line	:
City	:	MILES CITY
State	:	MT
Zip	:	59301-5000
Country	:	US
Telephone Number	:	406-234-1687
Fax Number	:	406-234-1698

Authorized Official
Title or Position	:	CHIEF INFORMATION OFFICER
Name	:	KATHY K BEASON
Credential	:
Telephone Number	:	406-234-0234

Provider Enumeration Date	:	11/08/2005
Last Update Date	:	01/21/2025

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1104048073 — MS. DENISE J HEITLER LCSW
Practice Location Address:

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1275790289 — MS. LISA A WILLIAMS LCPC, LAC
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1942461223 — CODY ELIZABETH PORTWINE-KINZER LCSW
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Directions to “EASTERN MONTANA COMMUNITY MENTAL HEALTH CENTER ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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