Organization
WAXWING PSYCHOTHERAPY LIMITED LIABILITY PARTNERSHIP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SAMUEL ORE LCSW (OWNER)
(406) 241-1693
Entity
Organization
Contact information
Practice address
2 6TH AVE E, POLSON, MT 59860-2726
(406) 241-1693
Mailing address
2 6TH AVE E, POLSON, MT 59860-2726
(406) 241-1693
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1215405246
—
MT
05
—
1568842060
—
MT
Enumeration date
11/16/2018
Last updated
06/05/2020
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