Provider Demographics
NPI:1033347687
Name:NIELSON, ROCHELLE TAGUE (MS)
Entity Type:Individual
Prefix:MS
First Name:ROCHELLE
Middle Name:TAGUE
Last Name:NIELSON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 E MAIN ST STE 312
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-4721
Mailing Address - Country:US
Mailing Address - Phone:406-579-7008
Mailing Address - Fax:
Practice Address - Street 1:321 E MAIN ST STE 312
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-4721
Practice Address - Country:US
Practice Address - Phone:406-579-7008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-22
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1416101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional