Provider Demographics
NPI:1942767256
Name:STILLWATERS BEHAVIORAL HEALTH LLC
Entity Type:Organization
Organization Name:STILLWATERS BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:BAZINET
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:406-465-4580
Mailing Address - Street 1:PO BOX 9736
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59604-9736
Mailing Address - Country:US
Mailing Address - Phone:406-465-4580
Mailing Address - Fax:
Practice Address - Street 1:44 N LAST CHANCE GULCH STE 2
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-4158
Practice Address - Country:US
Practice Address - Phone:406-465-4580
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-22
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT563890Medicaid