MOUNTAIN HOME MONTANA, INC. (NPI# 1265752034) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1265752034 |
| Entity Type | Organization |
| Organization Name | MOUNTAIN HOME MONTANA, INC. |
| Practice Address |
2606 South Ave W Missoula MT 59804-6406 |
| Practice Telephone | 4065414663 |
| Practice Fax Number | 4065414662 |
| Mailing Telephone | 4065414663 |
| Mailing Fax Number | 4065414662 |
| Enumeration Date | 2010-06-03 |
| Last Update Date | 2013-05-07 |
| Authorized Official Name | MRS. GYPSY RAY (CLINICAL DIRECTOR) |
| Authorized Official Telephone | 4065414663 |
| Authorized Official Credential | L.C.S.W. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 251B00000X | Case Management | 13491 | MT | Agencies |
| N | 251S00000X | Community/Behavioral Health | 13491 | MT | Agencies |
| Y | 251S00000X | Community/Behavioral Health | 709LCSW | MT | Agencies |
| Street Address |
2606 SOUTH AVE W |
| City | MISSOULA |
| State | MT |
| Zip Code | 59804-6406 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558713289 | Erin Stacy Houge | Social Worker | 2606 South Ave W, Missoula, MT 59804-6400 | 2016-07-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063019297 | Momentum Speech Therapy, PC | Speech-Language Pathologist | 9885 O'brien Creek Road, Missoula, MT 59804 | 2020-10-01 |
| 1033633037 | Marissa Clark | Genetic Counselor, MS | 2827 Fort Missoula Rd., Suite 317, Missoula, MT 59804 | 2017-08-01 |
| 1104295245 | Scott Richter | Specialist/Technologist | 2892 Ringo Dr, Missoula, MT 59804 | 2015-09-18 |
| 1467860353 | Zachary Ueland | Pharmacist | 4000 Highway 93 South, Missoula, MT 59804 | 2014-07-24 |
| 1316378185 | Tracy Laurel Brothers | Counselor | 1305 Wyoming Street, Missoula, MT 59804 | 2013-12-04 |
| 1447683651 | Granite Pharmacy Missoula, LLC | Durable Medical Equipment & Medical Supplies | 2230 27th Ave. West, Suite 2, Missoula, MT 59804 | 2013-08-12 |
| 1871843953 | Autum Emerson Howell | Nurse Practitioner | 2831 Ft. Missoula Rd. Bldg 2, 102, Missoula, MT 59804 | 2012-09-14 |
| 1821353939 | Carlyn Doyle | Nurse Practitioner | 2835 Fort Missoula Rd Ste 203, Missoula, MT 59804 | 2012-07-05 |
| 1396011961 | Patricia Jean Evans | Internal Medicine | 702 S.w. Higgins, First Choice Medical Clinic, Missoula, MT 59804 | 2012-03-28 |
| 1205126794 | Pacific Medical, Inc. | Prosthetic/Orthotic Supplier | 2732 South Ave West, Suite 202, Missoula, MT 59804 | 2011-04-18 |
| Find all providers in zip 59804 | ||||
| Taxonomy Code | 251S00000X |
| Grouping | Agencies |
| Classification | Community/Behavioral Health |
| A private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, mental retardation, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment. |
| Notes: Source: National Medicaid EDI HIPAA NPI Sub Work Group [1/1/2007: modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134641640 | Michelle Moles Lcsw Lac | Community/Behavioral Health | 101 E Broadway St Ste 602, Missoula, MT 59802-4594 | 2017-07-17 |
| 1114160504 | Kristen Kallemeyn | Community/Behavioral Health | 511 Rollins St, Missoula, MT 59801-3720 | 2009-04-14 |
| 1649390881 | Friends To Youth Inc. | Community/Behavioral Health | 1515 E Broadway St, Missoula, MT 59802-4929 | 2007-03-30 |
| 1912079328 | Western Montana Mental Health Center | Community/Behavioral Health | 1321 Wyoming St, Missoula, MT 59801-1725 | 2006-11-14 |
| 1134757198 | Ideal Balance Pllc | Community/Behavioral Health | 2685 Palmer St Ste D, Missoula, MT 59808-1709 | 2020-03-27 |
| 1205390861 | Larissa Olson, Lcsw Pllc | Community/Behavioral Health | 690 Sw Higgins Ave Ste B, Missoula, MT 59803-1433 | 2019-01-29 |
| 1720569213 | Mitch Guerette Lcsw LLC | Community/Behavioral Health | 1001 Sw Higgins Ave Ste 206, Missoula, MT 59803-1340 | 2018-08-23 |
| 1518409846 | Simply Assessments | Community/Behavioral Health | 2798 Meriwether St, Missoula, MT 59803-2934 | 2016-11-17 |
| 1720539745 | Valeo Behavioral Health, LLC | Community/Behavioral Health | 1600 North Ave W Ste 106, Missoula, MT 59801-5500 | 2016-10-14 |
| 1306393194 | Dana Eisenberg, Lcsw Counseling and Consultation, LLC | Community/Behavioral Health | 528 Cleveland St, Missoula, MT 59801-3743 | 2016-09-08 |
| Find all providers in MISSOULA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.