Provider Demographics
NPI:1457863664
Name:MONTANA CENTER FOR SOMATIC PSYCHOTHERAPY
Entity Type:Organization
Organization Name:MONTANA CENTER FOR SOMATIC PSYCHOTHERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HILLARY
Authorized Official - Middle Name:SWAN
Authorized Official - Last Name:WELZENBACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-541-2662
Mailing Address - Street 1:2237 S. 3RD ST. W.
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-1334
Mailing Address - Country:US
Mailing Address - Phone:406-541-2662
Mailing Address - Fax:
Practice Address - Street 1:2237 S. 3RD ST. W.
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-1334
Practice Address - Country:US
Practice Address - Phone:406-541-2662
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-27
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1912164831OtherNPI