Organization
WESTERN MONTANA MENTAL HEALTH CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KIMBERLEY MICHELLE PETERSEN N.P. (PSYCHIATRIC NURSE PRACTITIONER)
(406) 532-9700
Entity
Organization
Contact information
Practice address
1315 WYOMING ST, MISSOULA, MT 59801-1725
(406) 432-9700
(406) 541-3035
Mailing address
1315 WYOMING STREET, MISSOULA, MT 59801
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
25102
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1508000878
NPI
MT
Enumeration date
03/25/2014
Last updated
03/25/2014
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