Provider Demographics
NPI:1942650601
Name:THERAPEUTIC MENTORING
Entity Type:Organization
Organization Name:THERAPEUTIC MENTORING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:THADDEUS
Authorized Official - Middle Name:J
Authorized Official - Last Name:WIDMER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:406-531-8846
Mailing Address - Street 1:PO BOX 676
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:MT
Mailing Address - Zip Code:59840-0676
Mailing Address - Country:US
Mailing Address - Phone:406-531-8846
Mailing Address - Fax:
Practice Address - Street 1:140 CHERRY ST
Practice Address - Street 2:STE 202
Practice Address - City:HAMILTON
Practice Address - State:MT
Practice Address - Zip Code:59840-3517
Practice Address - Country:US
Practice Address - Phone:406-531-8846
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-14
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT8601041C0700X
MT8721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty