| |
690 N Meridian Rd Ste 204 Kalispell MT 59901-3508 | |
(406) 249-5611 | |
Not Available |
Full Name | |
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Speciality | Counselor |
Location | 690 N Meridian Rd Ste 204, Kalispell, Montana |
Authorized Official Name and Position | Daniel L. Gregerson (OWNER) |
Authorized Official Contact | 4062495611 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 935 Marion MT 59925-0935 Ph: (406) 249-5611 | 690 N Meridian Rd Ste 204 Kalispell MT 59901-3508 Ph: (406) 249-5611 |
NPI Number | 1154183705 |
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Provider Enumeration Date | 01/29/2024 |
Last Update Date | 11/27/2024 |
Certification Date | 11/27/2024 |
Medicare PECOS PAC ID | 6901241587 |
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Medicare Enrollment ID | O20240305003682 |
Identifier | Type | State | Issuer |
---|---|---|---|
1154183705 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
Provider Name | Daniel L Gregerson |
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Provider Type | Practitioner - Mental Health Counselor |
Provider Identifiers | NPI Number: 1033236344 PECOS PAC ID: 7719322395 Enrollment ID: I20240326001158 |
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