Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 25784 | MT |
N | 106S00000X | Behavior Technician | ||
N | 225C00000X | Rehabilitation Counselor | 00118429 | MT |
NPI | 1194235697 |
---|---|
Provider Name | Matthew Wenzel |
First Address | Ronan, MT 59864-3304 |
Second Address | Polson, MT 59860-5328 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2017 |
Last Update Date | 10/10/2017 |