| Wake Mental Health Llc | |
|
428 1st Ave W Kalispell MT 59901-4836 | |
| (406) 253-1807 | |
| Not Available |
| Full Name | Wake Mental Health Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 428 1st Ave W, Kalispell, Montana |
| Authorized Official Name and Position | Jill A Dieser (CLINCIAL SOCIAL WORKER) |
| Authorized Official Contact | 4062619127 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wake Mental Health Llc 410 10th Ave W Kalispell MT 59901-4724 Ph: (406) 261-9127 | Wake Mental Health Llc 428 1st Ave W Kalispell MT 59901-4836 Ph: (406) 253-1807 |
| NPI Number | 1700473253 |
|---|---|
| Provider Enumeration Date | 12/30/2020 |
| Last Update Date | 12/30/2020 |
| Certification Date | 12/30/2020 |
| Medicare PECOS PAC ID | 7315352986 |
|---|---|
| Medicare Enrollment ID | O20210211001612 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700473253 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Jill Dieser |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1831705318 PECOS PAC ID: 8224443890 Enrollment ID: I20210211001747 |
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