Provider Demographics
NPI:1598085136
Name:DANCING SUN, LTD
Entity type:Organization
Organization Name:DANCING SUN, LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LCSW
Authorized Official - Prefix:
Authorized Official - First Name:JONI
Authorized Official - Middle Name:
Authorized Official - Last Name:MAMICA
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:406-260-2281
Mailing Address - Street 1:PO BOX 8955
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59904-1955
Mailing Address - Country:US
Mailing Address - Phone:406-260-2281
Mailing Address - Fax:206-350-5470
Practice Address - Street 1:38 E WASHINGTON ST
Practice Address - Street 2:#3
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-3975
Practice Address - Country:US
Practice Address - Phone:406-260-2281
Practice Address - Fax:206-350-5470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-06
Last Update Date:2010-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTLCS 757251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health