Provider Demographics
NPI:1760703474
Name:INTERMOUNTAIN DEACONNESS HOME FOR CHILDREN
Entity Type:Organization
Organization Name:INTERMOUNTAIN DEACONNESS HOME FOR CHILDREN
Other - Org Name:INTERMOUNTAIN CHILD & FAMILY PSYCHOLOGICAL CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:CAO
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-457-4822
Mailing Address - Street 1:3240 DREDGE DR
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59602-0548
Mailing Address - Country:US
Mailing Address - Phone:406-442-7920
Mailing Address - Fax:406-442-7949
Practice Address - Street 1:322 2ND AVE W STE A
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-4867
Practice Address - Country:US
Practice Address - Phone:406-755-4022
Practice Address - Fax:406-755-4023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-16
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty