Provider Demographics
NPI: | 1992958714 |
---|---|
Name: | SOUND VIEW COUNSELING & ASSOC.PS, INC. |
Entity type: | Organization |
Organization Name: | SOUND VIEW COUNSELING & ASSOC.PS, INC. |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | DESSYE-DEE |
Authorized Official - Middle Name: | M |
Authorized Official - Last Name: | CLARK |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | PHD, APRN |
Authorized Official - Phone: | 406-541-4436 |
Mailing Address - Street 1: | 301 W SPRUCE ST |
Mailing Address - Street 2: | |
Mailing Address - City: | MISSOULA |
Mailing Address - State: | MT |
Mailing Address - Zip Code: | 59802-4107 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 406-541-4436 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 301 W SPRUCE ST |
Practice Address - Street 2: | |
Practice Address - City: | MISSOULA |
Practice Address - State: | MT |
Practice Address - Zip Code: | 59802-4107 |
Practice Address - Country: | US |
Practice Address - Phone: | 406-541-4436 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2008-10-23 |
Last Update Date: | 2008-10-23 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
MT | 29998 | 251S00000X, 364SP0807X, 364SP0809X, 364SP0810X, 364SP0811X, 364SP0812X |
MT | 9525 | 363LF0000X, 363LP0808X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 363LP0808X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psychiatric/Mental Health | Group - Multi-Specialty |
No | 251S00000X | Agencies | Community/Behavioral Health | Group - Multi-Specialty | |
No | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | Group - Multi-Specialty |
No | 364SP0807X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psychiatric/Mental Health, Child & Adolescent | Group - Multi-Specialty |
No | 364SP0809X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psychiatric/Mental Health, Adult | Group - Multi-Specialty |
No | 364SP0810X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psychiatric/Mental Health, Child & Family | Group - Multi-Specialty |
No | 364SP0811X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psychiatric/Mental Health, Chronically Ill | Group - Multi-Specialty |
No | 364SP0812X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psychiatric/Mental Health, Community | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
MT | 1578574067 | Other | NPI |
MT | 1801802855 | Other | NPI |
MT | 4304872 | Medicaid |