Waxwing Psychotherapy Limited Liability Partnership

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

WAXWING PSYCHOTHERAPY LIMITED LIABILITY PARTNERSHIP

Practice address

2 6TH Ave E
Polson, MT 59860-2726

Phone

(406) 241-1693

NPI assigned

Nov 16, 2018

Organization subpart

No

Name

Mr. Samuel Ore, LCSWNPI 1215405246

Title

Owner

Phone

(406) 241-1693

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

• Samuel Hepburn Ore, LCSW

  • Clinical Social Worker
  • Polson, MT
  • NPI 1215405246

  Clinical, MT

  Medicare reassignment Care Compare group NPD Authorized official
• Patrick James Schuler, LCSW, LAC

  • Clinical Social Worker
  • Missoula, MT
  • NPI 1427315258

  Clinical, MT

  Medicare reassignment Care Compare group NPD
• Leah Mack Ore, LCSW

  • Clinical Social Worker
  • Missoula, MT
  • NPI 1568842060

  Clinical, MT

  Medicare reassignment NPD
• Andrew Richard Laue, L.C.S.W.

  • Clinical Social Worker
  • Missoula, MT
  • NPI 1437213048

  Clinical

  NPD (past)
• Kimberly Rae McDonald-Markuson, LCSW

  • Clinical Social Worker
  • Missoula, MT
  • NPI 1770140907

  Clinical

  NPD (past)
• Meghan Elizabeth Yeomans, LCSW, LAC

  • Clinical Social Worker
  • Missoula, MT
  • NPI 1679950034

  Clinical

  NPD (past)
• Raquel Teresa Castellanos Miller, LCSW

  • Clinical Social Worker
  • Richmond, CA
  • NPI 1588179642

  Clinical

  NPD (past)

Medicare fee-for-service enrollment

Enrolled in MT

Locations

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jun 5, 2020.

{
    "created_epoch": "1542326400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1591315200000",
    "number": "1669941936",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 6TH AVE E",
            "city": "POLSON",
            "state": "MT",
            "postal_code": "598602726",
            "telephone_number": "406-241-1693"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 6TH AVE E",
            "city": "POLSON",
            "state": "MT",
            "postal_code": "598602726",
            "telephone_number": "406-241-1693"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAXWING PSYCHOTHERAPY LIMITED LIABILITY PARTNERSHIP",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-11-16",
        "last_updated": "2020-06-05",
        "certification_date": "2020-06-05",
        "status": "A",
        "authorized_official_last_name": "ORE",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "406-241-1693",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1568842060",
            "state": "MT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1215405246",
            "state": "MT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Walgreen Co
• Kaelen Christine Wall, RN
• Walmart Inc.
• Kathleen M Watkins, B.A. LAC
• Waves of Change Counseling, LLC
• Susan Weaselhead, LCPC
• Christopher James Weber, LCSW
• Erika Ann Weber, LCSW
• Western Montana Area 6 Agency on Aging
• Western Montana Clinic PC

• All providers in Polson, MT
• Clinical Social Worker in Montana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.