Provider Demographics
NPI:1700473253
Name:WAKE MENTAL HEALTH LLC
Entity type:Organization
Organization Name:WAKE MENTAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:DIESER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-253-1807
Mailing Address - Street 1:PO BOX 3206
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59903-3206
Mailing Address - Country:US
Mailing Address - Phone:406-253-1807
Mailing Address - Fax:
Practice Address - Street 1:1077 WHITEFISH STAGE ROAD
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-2735
Practice Address - Country:US
Practice Address - Phone:406-253-1807
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-30
Last Update Date:2025-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty