Provider Demographics
NPI:1356796676
Name:PINNACLE WELLNESS, LLC
Entity type:Organization
Organization Name:PINNACLE WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:ERIKA
Authorized Official - Middle Name:F
Authorized Official - Last Name:BIDLAKE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:602-316-3488
Mailing Address - Street 1:PO BOX 9185
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59807-9185
Mailing Address - Country:US
Mailing Address - Phone:406-272-2224
Mailing Address - Fax:406-721-2833
Practice Address - Street 1:336 W SPRUCE ST
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-4108
Practice Address - Country:US
Practice Address - Phone:406-272-2224
Practice Address - Fax:406-721-2833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-25
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT2356-LCSW251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health