Provider Demographics
NPI:1528874104
Name:ELEVATE MONTANA MENTAL HEALTH
Entity type:Organization
Organization Name:ELEVATE MONTANA MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MS
Authorized Official - First Name:RACHAEL
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:DUNKEL
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC, LAC
Authorized Official - Phone:406-595-1374
Mailing Address - Street 1:77 STAGECOACH TRAIL RD
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:MT
Mailing Address - Zip Code:59741-8295
Mailing Address - Country:US
Mailing Address - Phone:406-595-1374
Mailing Address - Fax:
Practice Address - Street 1:714 STONERIDGE DR STE 1
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-7046
Practice Address - Country:US
Practice Address - Phone:406-595-1374
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-09
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty