Provider Demographics
NPI:1942699350
Name:BIG SKY MENTAL HEALTH SERVICES PLLC
Entity Type:Organization
Organization Name:BIG SKY MENTAL HEALTH SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ELEANOR
Authorized Official - Middle Name:P
Authorized Official - Last Name:LAVIN
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, BC, CNS
Authorized Official - Phone:406-234-7890
Mailing Address - Street 1:PO BOX 1531
Mailing Address - Street 2:
Mailing Address - City:MILES CITY
Mailing Address - State:MT
Mailing Address - Zip Code:59301
Mailing Address - Country:US
Mailing Address - Phone:406-234-7890
Mailing Address - Fax:
Practice Address - Street 1:2000 CLARK ST.
Practice Address - Street 2:
Practice Address - City:MILES CITY
Practice Address - State:MT
Practice Address - Zip Code:59301-2726
Practice Address - Country:US
Practice Address - Phone:406-234-7890
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-22
Last Update Date:2015-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT12752363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty