| Medicine Lodge Counseling Pllc | |
|
2809 Great Northern Loop Ste 210-5 Missoula MT 59808-1749 | |
| (406) 360-8470 | |
| Not Available |
| Full Name | Medicine Lodge Counseling Pllc |
|---|---|
| Speciality | Counselor |
| Location | 2809 Great Northern Loop Ste 210-5, Missoula, Montana |
| Authorized Official Name and Position | Pamela C Wilson (CLINICAL MENTAL HEALTH COUNSELOR) |
| Authorized Official Contact | 4063608470 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Medicine Lodge Counseling Pllc 14098 Jenny Ann Ct Unit A Missoula MT 59808-5386 Ph: (406) 360-8470 | Medicine Lodge Counseling Pllc 2809 Great Northern Loop Ste 210-5 Missoula MT 59808-1749 Ph: (406) 360-8470 |
| NPI Number | 1619465788 |
|---|---|
| Provider Enumeration Date | 04/24/2018 |
| Last Update Date | 06/16/2018 |
| Medicare PECOS PAC ID | 7719320480 |
|---|---|
| Medicare Enrollment ID | O20240209000737 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619465788 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | 4654 (Montana) | Primary |
| Provider Name | Pamela C. Wilson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1144656455 PECOS PAC ID: 8628411394 Enrollment ID: I20240209000792 |
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