| Living Well, Llc | |
|
400 W Main St Ste 203 Hamilton MT 59840-2443 | |
| (406) 363-2873 | |
| Not Available |
| Full Name | Living Well, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 400 W Main St Ste 203, Hamilton, Montana |
| Authorized Official Name and Position | Kellie Mildenberger (OWNER/THERAPIST) |
| Authorized Official Contact | 4063632873 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Living Well, Llc Po Box 1707 Hamilton MT 59840-1707 Ph: () - | Living Well, Llc 400 W Main St Ste 203 Hamilton MT 59840-2443 Ph: (406) 363-2873 |
| NPI Number | 1639686462 |
|---|---|
| Provider Enumeration Date | 01/02/2018 |
| Last Update Date | 03/28/2018 |
| Medicare PECOS PAC ID | 4385903673 |
|---|---|
| Medicare Enrollment ID | O20180111002851 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639686462 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | BBH-LCSW-LIC-12274 (Montana) | Primary |
| 1041C0700X | Social Worker - Clinical | 7731-C (Nevada) | Secondary |
| Provider Name | Kellie D Mildenberger |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1356726111 PECOS PAC ID: 3173838307 Enrollment ID: I20150818004635 |
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