Provider Demographics
NPI:1013543347
Name:TWO RIVERS WELLNESS
Entity Type:Organization
Organization Name:TWO RIVERS WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FNP-C, PMHNP-BC
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:L
Authorized Official - Last Name:WETHERELT
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:406-234-2929
Mailing Address - Street 1:1552 CARTERSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:ROSEBUD
Mailing Address - State:MT
Mailing Address - Zip Code:59347-9522
Mailing Address - Country:US
Mailing Address - Phone:406-351-2196
Mailing Address - Fax:406-234-2928
Practice Address - Street 1:2911 WILSON ST
Practice Address - Street 2:
Practice Address - City:MILES CITY
Practice Address - State:MT
Practice Address - Zip Code:59301-5722
Practice Address - Country:US
Practice Address - Phone:406-234-2929
Practice Address - Fax:406-234-2928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-18
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use DisorderGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT4307966Medicaid