| Waxwing Psychotherapy Limited Liability Partnership | |
|
2 6th Ave E Polson MT 59860-2726 | |
| (406) 241-1693 | |
| Not Available |
| Full Name | Waxwing Psychotherapy Limited Liability Partnership |
|---|---|
| Speciality | Social Worker |
| Location | 2 6th Ave E, Polson, Montana |
| Authorized Official Name and Position | Samuel Ore (OWNER) |
| Authorized Official Contact | 4062411693 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Waxwing Psychotherapy Limited Liability Partnership 2 6th Ave E Polson MT 59860-2726 Ph: (406) 241-1693 | Waxwing Psychotherapy Limited Liability Partnership 2 6th Ave E Polson MT 59860-2726 Ph: (406) 241-1693 |
| NPI Number | 1669941936 |
|---|---|
| Provider Enumeration Date | 11/16/2018 |
| Last Update Date | 06/05/2020 |
| Certification Date | 06/05/2020 |
| Medicare PECOS PAC ID | 4183045651 |
|---|---|
| Medicare Enrollment ID | O20200609002194 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669941936 | NPI | - | NPPES |
| 1568842060 | Medicaid | MT | |
| 1215405246 | Medicaid | MT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Samuel Hepburn Ore |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1215405246 PECOS PAC ID: 5092136564 Enrollment ID: I20200612002462 |
| Provider Name | Leah Mack Ore |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1568842060 PECOS PAC ID: 0446671911 Enrollment ID: I20201008001762 |
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