Provider Demographics
NPI:1609604578
Name:LONE WOLF COUNSELING, LLC
Entity type:Organization
Organization Name:LONE WOLF COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOUSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-590-1550
Mailing Address - Street 1:1601 2ND AVE N STE 208
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59401-3286
Mailing Address - Country:US
Mailing Address - Phone:406-590-1550
Mailing Address - Fax:
Practice Address - Street 1:1601 2ND AVE N STE 208
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59401-3286
Practice Address - Country:US
Practice Address - Phone:406-590-1550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-23
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health