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1048 Helena Ave Ste 101 Helena MT 59601-3573 | |
| (406) 302-1333 | |
| (406) 449-8828 |
| Full Name | |
|---|---|
| Speciality | Social Worker |
| Location | 1048 Helena Ave Ste 101, Helena, Montana |
| Authorized Official Name and Position | Theresa Lee (OWNER) |
| Authorized Official Contact | 4063021333 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
1048 Helena Ave Ste 101 Helena MT 59601-3573 Ph: (406) 302-1333 | 1048 Helena Ave Ste 101 Helena MT 59601-3573 Ph: (406) 302-1333 |
| NPI Number | 1780168401 |
|---|---|
| Provider Enumeration Date | 09/19/2018 |
| Last Update Date | 08/27/2020 |
| Certification Date | 08/27/2020 |
| Medicare PECOS PAC ID | 9739421397 |
|---|---|
| Medicare Enrollment ID | O20190430002636 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780168401 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Theresa Lynn Lee |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1306356100 PECOS PAC ID: 6204178858 Enrollment ID: I20190430002524 |
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