Facts
- Status
- A
- Type
- Individual
- Enumeration date
- 2021-05-11
- Last updated
- 2021-05-11
Specialties
Licenses
- License MT
- BBH-LCSW-LIC-38995
Location
- Practice location
- 633 COLORADO AVE
- City
- WHITEFISH MT
- Postal code
- 599373408
- Phone
- 406-249-8694
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
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Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.