Provider Demographics
NPI:1174172621
Name:CABINET MOUNTAIN COUNSELING PC
Entity type:Organization
Organization Name:CABINET MOUNTAIN COUNSELING PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RAOUL
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:RIBEIRO
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:406-827-0345
Mailing Address - Street 1:109 SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:THOMPSON FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59873-9426
Mailing Address - Country:US
Mailing Address - Phone:406-827-0345
Mailing Address - Fax:
Practice Address - Street 1:109 SPRUCE ST
Practice Address - Street 2:
Practice Address - City:THOMPSON FALLS
Practice Address - State:MT
Practice Address - Zip Code:59873-9426
Practice Address - Country:US
Practice Address - Phone:406-827-0345
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-07
Last Update Date:2019-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1972841666Medicaid