Basic Information
| Provider Information | |||||||||
| NPI: | 1992786784 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EASTERN MONTANA COMMUNITY MENTAL HEALTH CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1530 | ||||||||
| Address2: | |||||||||
| City: | MILES CITY | ||||||||
| State: | MT | ||||||||
| PostalCode: | 593011530 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4062340234 | ||||||||
| FaxNumber: | 4062340235 | ||||||||
| Practice Location | |||||||||
| Address1: | 2508 WILSON ST | ||||||||
| Address2: | |||||||||
| City: | MILES CITY | ||||||||
| State: | MT | ||||||||
| PostalCode: | 593015000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4062341687 | ||||||||
| FaxNumber: | 4062341698 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/08/2005 | ||||||||
| LastUpdateDate: | 07/30/2020 | ||||||||
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| AuthorizedOfficialLastName: | BEASON | ||||||||
| AuthorizedOfficialFirstName: | KATHY | ||||||||
| AuthorizedOfficialMiddleName: | K | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF INFORMATION OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 4062340234 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 07/30/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YM0800X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health | 261QR0405X | N | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder | 1041C0700X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical | 363LP0808X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health | 261QM0801X | 10392 | MT | Y | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
ID Information
| ID | Type | State | Issuer | Description | 0439212 | 05 | MT | MEDICAID | 0491470 | 05 | MT | MEDICAID | 0502418 | 05 | MT | MEDICAID | 0320112 | 05 | MT | MEDICAID | 0255527 | 05 | MT | MEDICAID | 0290147 | 05 | MT | MEDICAID | 75031 | 01 | MT | BS/BS PROVIDER # | OTHER | 0402142 | 05 | MT | MEDICAID |