Organization
WESTERN PINE PSYCHOTHERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EMILIE BURKE LCSW (OWNER, CLINICAL SOCIAL WORKER)
(406) 546-1745
Entity
Organization
Contact information
Practice address
2100 S HIGGINS AVE, MISSOULA, MT 59801-6761
(406) 546-1745
Mailing address
2617 GARLAND DR, MISSOULA, MT 59803-2009
(406) 546-1745
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BBH-LCSW-LIC-32067
STATE OF MONTANA BUSINESS STANDARDS DIVISION BOARD OF BEHAVIORAL HEALTH
MT
Enumeration date
04/09/2019
Last updated
04/09/2019
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