Provider Demographics
NPI:1194365296
Name:TREASURE STATE PSYCHOLOGICAL SERVICES, INC
Entity Type:Organization
Organization Name:TREASURE STATE PSYCHOLOGICAL SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:KLAJIC
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:406-594-1168
Mailing Address - Street 1:2047 N LAST CHANCE GULCH # 160
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-0744
Mailing Address - Country:US
Mailing Address - Phone:406-594-1168
Mailing Address - Fax:
Practice Address - Street 1:4185 N MONTANA AVE STE 5
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59602-7668
Practice Address - Country:US
Practice Address - Phone:406-594-1168
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-07
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty