Provider Demographics
NPI:1205165735
Name:SAFE HARBOR THERAPEUTIC SERVICES LLC
Entity type:Organization
Organization Name:SAFE HARBOR THERAPEUTIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:MURI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, LAC
Authorized Official - Phone:406-696-2246
Mailing Address - Street 1:PO BOX 21292
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59104-1292
Mailing Address - Country:US
Mailing Address - Phone:406-696-2246
Mailing Address - Fax:406-896-0231
Practice Address - Street 1:2475 VILLAGE LN
Practice Address - Street 2:STE 102
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-2497
Practice Address - Country:US
Practice Address - Phone:406-696-2246
Practice Address - Fax:406-896-0231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-11
Last Update Date:2009-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1130 LAC101YA0400X
MT841-LCSW1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1710128764Medicaid