Provider Demographics
NPI:1033397146
Name:SOUTHWEST MONTANA NEUROPSYCHOLOGY SERVICES, PLLC
Entity Type:Organization
Organization Name:SOUTHWEST MONTANA NEUROPSYCHOLOGY SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / CLINICAL NEUROPSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:AUDREY
Authorized Official - Middle Name:J
Authorized Official - Last Name:MATTSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:406-782-4597
Mailing Address - Street 1:PO BOX 223
Mailing Address - Street 2:
Mailing Address - City:WARM SPRINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59756-0223
Mailing Address - Country:US
Mailing Address - Phone:406-693-2103
Mailing Address - Fax:406-782-1347
Practice Address - Street 1:800 W PLATINUM ST STE F
Practice Address - Street 2:
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-2200
Practice Address - Country:US
Practice Address - Phone:406-782-4597
Practice Address - Fax:406-782-1347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-31
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty