Provider Demographics
NPI:1760201982
Name:WELLNESS RECOVERY GROUP PLLC
Entity type:Organization
Organization Name:WELLNESS RECOVERY GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:JOAN
Authorized Official - Last Name:FORAN
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT, LCPC, LAC
Authorized Official - Phone:406-540-2846
Mailing Address - Street 1:PO BOX 1737
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59806-1737
Mailing Address - Country:US
Mailing Address - Phone:406-540-2846
Mailing Address - Fax:
Practice Address - Street 1:3425 SGT SANDERS ST
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59804-7224
Practice Address - Country:US
Practice Address - Phone:406-540-2846
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-04
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder