Provider Demographics
NPI:1043035538
Name:LUPINE MENTAL HEALTH AND WELLNESS
Entity type:Organization
Organization Name:LUPINE MENTAL HEALTH AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:MITTELSTADT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-285-8929
Mailing Address - Street 1:PO BOX 272
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59624-0272
Mailing Address - Country:US
Mailing Address - Phone:406-285-8929
Mailing Address - Fax:
Practice Address - Street 1:32 S EWING ST STE 318
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-5750
Practice Address - Country:US
Practice Address - Phone:406-285-8929
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-19
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty