Provider Demographics
NPI:1043085095
Name:MOUNTAIN WELLNESS THERAPY LLC
Entity Type:Organization
Organization Name:MOUNTAIN WELLNESS THERAPY LLC
Other - Org Name:MOUNTAIN WELLNESS THERAPY LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEWEES
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC, LAC
Authorized Official - Phone:406-220-7893
Mailing Address - Street 1:515 W PARK ST
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:MT
Mailing Address - Zip Code:59047-2530
Mailing Address - Country:US
Mailing Address - Phone:406-220-7893
Mailing Address - Fax:
Practice Address - Street 1:515 W PARK ST
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:MT
Practice Address - Zip Code:59047-2530
Practice Address - Country:US
Practice Address - Phone:406-220-7893
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-20
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty