Provider Demographics
NPI:1114810082
Name:THAYNE COUNSELING AND WELLNESS
Entity type:Organization
Organization Name:THAYNE COUNSELING AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:THAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:801-427-2607
Mailing Address - Street 1:PO BOX 581
Mailing Address - Street 2:
Mailing Address - City:DARBY
Mailing Address - State:MT
Mailing Address - Zip Code:59829-0581
Mailing Address - Country:US
Mailing Address - Phone:801-427-2607
Mailing Address - Fax:
Practice Address - Street 1:99 MARCUS ST FL 3
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:MT
Practice Address - Zip Code:59840-2598
Practice Address - Country:US
Practice Address - Phone:801-427-2607
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-30
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1245918416Medicaid