Provider Demographics
NPI:1861279507
Name:WILSON INTEGRATED PSYCHIATRY LLC
Entity type:Organization
Organization Name:WILSON INTEGRATED PSYCHIATRY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SARINA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:406-641-2345
Mailing Address - Street 1:504 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:STEVENSVILLE
Mailing Address - State:MT
Mailing Address - Zip Code:59870-2836
Mailing Address - Country:US
Mailing Address - Phone:406-641-2345
Mailing Address - Fax:406-720-7989
Practice Address - Street 1:504 MAIN ST
Practice Address - Street 2:
Practice Address - City:STEVENSVILLE
Practice Address - State:MT
Practice Address - Zip Code:59870-2836
Practice Address - Country:US
Practice Address - Phone:406-641-2345
Practice Address - Fax:406-720-7989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-14
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center