| NPI | 1194107003 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHANTELLE PLAUCHE Administrator 406-223-3621 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: MT 13496) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry | |
| 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder | |
| 320800000X Community Based Residential Treatment Facility, Mental Illness (Licence: MT 13496) | |
| Enumeration Date | 2015-06-27 |
| Last Update Date | 2020-10-30 |