Basic Information
| Provider Information | |||||||||
| NPI: | 1619516903 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SHINING VALLEY LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 33 | ||||||||
| Address2: | |||||||||
| City: | ARLEE | ||||||||
| State: | MT | ||||||||
| PostalCode: | 598210033 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4062105136 | ||||||||
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| Practice Location | |||||||||
| Address1: | 72949 RICE LN | ||||||||
| Address2: | |||||||||
| City: | ARLEE | ||||||||
| State: | MT | ||||||||
| PostalCode: | 598219348 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4062105136 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/03/2020 | ||||||||
| LastUpdateDate: | 01/03/2020 | ||||||||
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| AuthorizedOfficialLastName: | SWANSON | ||||||||
| AuthorizedOfficialFirstName: | SHANLEY | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | LCSW | ||||||||
| AuthorizedOfficialTelephone: | 4062105136 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 01/03/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.