Provider Demographics
NPI:1386948453
Name:MISFITS, LLC
Entity type:Organization
Organization Name:MISFITS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:LORETTA
Authorized Official - Last Name:MESSERLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-868-7832
Mailing Address - Street 1:PO BOX 6325
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59406-6325
Mailing Address - Country:US
Mailing Address - Phone:406-868-7832
Mailing Address - Fax:
Practice Address - Street 1:1111 14TH ST S STE C
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-4656
Practice Address - Country:US
Practice Address - Phone:406-868-7832
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-04
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT90518261QR0405X
MT1026251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No251S00000XAgenciesCommunity/Behavioral Health