| Roots And Wings Counseling Willow Tree Wellness Llc | |
|
415 N Higgins Ave Suite 122 Missoula MT 59802-4557 | |
| (406) 203-6937 | |
| (844) 965-9168 |
| Full Name | Roots And Wings Counseling Willow Tree Wellness Llc |
|---|---|
| Speciality | Social Worker |
| Location | 415 N Higgins Ave, Missoula, Montana |
| Authorized Official Name and Position | Cynthia Randles (OWNER) |
| Authorized Official Contact | 4062036937 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Roots And Wings Counseling Willow Tree Wellness Llc 415 N Higgins Ave Suite 122 Missoula MT 59802-4557 Ph: (406) 203-6937 | Roots And Wings Counseling Willow Tree Wellness Llc 415 N Higgins Ave Suite 122 Missoula MT 59802-4557 Ph: (406) 203-6937 |
| NPI Number | 1407220767 |
|---|---|
| Provider Enumeration Date | 11/23/2015 |
| Last Update Date | 12/04/2015 |
| Medicare PECOS PAC ID | 2062713498 |
|---|---|
| Medicare Enrollment ID | O20151209000747 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407220767 | NPI | - | NPPES |
| 1043632177 | Other | MT | NPI AS INDIVIDUAL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 7134 (Montana) | Primary |
| Provider Name | Cynthia Nicole Randles |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1043632177 PECOS PAC ID: 3971804303 Enrollment ID: I20151209000879 |
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