Organization
LAKE COUNTY CHEMICAL DEPENDENCY PROGRAM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THERESA OAKLAND M.S. LAC (DIRECTOR)
(406) 883-7310
Entity
Organization
Contact information
Practice address
802 MAIN ST STE C, POLSON, MT 59860-3200
(406) 883-7310
(406) 883-7312
Mailing address
802 MAIN ST STE C, POLSON, MT 59860-3200
(406) 883-7310
(406) 883-7312
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
251
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0320099
—
MT
01
—
760850
BLUE CROSS BLUE SHIELD ID
MT
Enumeration date
07/06/2006
Last updated
08/22/2020
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