Provider Demographics
NPI:1083053367
Name:PSYCHIATRIC CONSULTANTS OF MONTANA, PLLC
Entity Type:Organization
Organization Name:PSYCHIATRIC CONSULTANTS OF MONTANA, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BERTRAM
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:406-491-0288
Mailing Address - Street 1:100 E BROADWAY ST
Mailing Address - Street 2:412
Mailing Address - City:BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59701-9351
Mailing Address - Country:US
Mailing Address - Phone:406-491-0288
Mailing Address - Fax:406-299-3339
Practice Address - Street 1:100 E BROADWAY ST
Practice Address - Street 2:412
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-9351
Practice Address - Country:US
Practice Address - Phone:406-491-0288
Practice Address - Fax:406-299-3339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-19
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTNURRNLIC67645363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty