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Organization
WESTERN MONTANA MENTAL HEALTH CENTER
Active
Organization
WESTERN MONTANA MENTAL HEALTH CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CORY DESTEIN (CHIEF ADMINISTRATIVE OFFICER)
(406) 532-8400
Entity
Organization
Contact information
Practice address
1321 WYOMING ST, MISSOULA, MT 59801-1725
(406) 532-8400
(406) 224-4402
Mailing address
1321 WYOMING ST, MISSOULA, MT 59801-1725
(406) 532-8400
(406) 224-4402
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YP2500X
Professional Counselor
—
—
1041C0700X
Clinical Social Worker
—
—
2084P0800X
Psychiatry Physician
—
—
251B00000X
Case Management Agency
11034
MT
251S00000X
Community/Behavioral Health Agency
11034
MT
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
11034
MT
261QM0850X
Adult Mental Health Clinic/Center
11034
MT
261QM0855X
Adolescent and Children Mental Health Clinic/Center
11034
MT
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
258 07
MT
320800000X
Mental Illness Community Based Residential Treatment Facility
—
—
323P00000X
Psychiatric Residential Treatment Facility
13459
MT
324500000X
Substance Abuse Rehabilitation Facility
13459
MT
363A00000X
Physician Assistant
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000008376
PTAN
MT
05
—
047379
—
MT
05
—
141232
—
MT
05
—
255425
—
MT
05
—
290108
—
MT
05
—
320177
—
MT
05
—
320385
—
MT
05
—
320424
—
MT
05
—
352248
—
MT
05
—
439161
—
MT
05
—
491419
—
MT
05
—
502316
—
MT
05
—
601647
—
MT
Enumeration date
11/14/2006
Last updated
05/28/2024
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