NPIMap

Organization Active NPI

Western Montana Mental Health Center

  • Mental Illness Community Based Residential Treatment Facility
  • Polson, MT
National Provider Identifier
1306202163
Registry record updated Jan 25, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X
License
12652 Issued in MT
Legal business name
WESTERN MONTANA MENTAL HEALTH CENTER
Practice address
7 13TH Ave East
Polson, MT 59860
Phone
(406) 532-8400
Fax
(406) 543-9316
NPI assigned
Jan 11, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 25, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jodi Daly, PHD
Title
Ceo
Phone
(406) 532-8400

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Illness Community Based Residential Treatment Facility 320800000X 12652 MT Primary

Addresses

Primary practice location

7 13TH Ave East
Polson, MT 59860

Mailing address

140 N Russell St
Missoula, MT 59801-1704
Phone (406) 532-8400

Other names 1

  • Lake House Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
27D2211806Western Montana Mental Health - Lake House7 13TH Avenue East, Polson, MT 59860Certificate of waiverJan 31, 2027

National Provider Directory

National Provider Directory
Tax ID family
WMRC Mental Health Ctr10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1452470400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1516838400000",
    "number": "1306202163",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "140 N RUSSELL ST",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598011704",
            "telephone_number": "406-532-8400",
            "fax_number": "406-224-4402"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7 13TH AVE EAST",
            "city": "POLSON",
            "state": "MT",
            "postal_code": "59860",
            "telephone_number": "406-532-8400",
            "fax_number": "406-543-9316"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WESTERN MONTANA MENTAL HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-01-11",
        "last_updated": "2018-01-25",
        "status": "A",
        "authorized_official_last_name": "DALY",
        "authorized_official_first_name": "JODI",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "406-532-8400",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "MT",
            "license": "12652",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lake House",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Polson, MT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.