| Mending Minds Therapy Llc | |
|
725 W Central Ave Ste 208 Missoula MT 59801-6800 | |
| (406) 926-1231 | |
| (406) 926-1231 |
| Full Name | Mending Minds Therapy Llc |
|---|---|
| Speciality | Social Worker |
| Location | 725 W Central Ave Ste 208, Missoula, Montana |
| Authorized Official Name and Position | Justina K Hagen (LCSW) |
| Authorized Official Contact | 4069261231 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mending Minds Therapy Llc 725 W Central Ave Ste 208 Missoula MT 59801-6800 Ph: (406) 926-1231 | Mending Minds Therapy Llc 725 W Central Ave Ste 208 Missoula MT 59801-6800 Ph: (406) 926-1231 |
| NPI Number | 1902311269 |
|---|---|
| Provider Enumeration Date | 12/08/2017 |
| Last Update Date | 12/08/2017 |
| Medicare PECOS PAC ID | 6507125580 |
|---|---|
| Medicare Enrollment ID | O20180119001999 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902311269 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | BBH-LCSW-LIC-18186 (Montana) | Primary |
| Provider Name | Justina K Dodge |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1821543000 PECOS PAC ID: 4587951801 Enrollment ID: I20160929001225 |
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