Provider Demographics
NPI:1639919178
Name:COLIBRI WELLNESS PLLC
Entity type:Organization
Organization Name:COLIBRI WELLNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:COLIBRI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:360-280-7593
Mailing Address - Street 1:1690 MILWAUKEE WAY,
Mailing Address - Street 2:#205
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-3028
Mailing Address - Country:US
Mailing Address - Phone:360-280-7593
Mailing Address - Fax:717-720-3916
Practice Address - Street 1:1690 MILWAUKEE WAY,
Practice Address - Street 2:#205
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-3028
Practice Address - Country:US
Practice Address - Phone:360-280-7593
Practice Address - Fax:717-720-3916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-31
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT001763699Medicaid