Provider Demographics
NPI:1225528110
Name:MISSOULA THERAPY, PLLC
Entity Type:Organization
Organization Name:MISSOULA THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:S
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, CBIS
Authorized Official - Phone:406-215-2225
Mailing Address - Street 1:3819 STEPHENS AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-8522
Mailing Address - Country:US
Mailing Address - Phone:406-215-2225
Mailing Address - Fax:406-215-2226
Practice Address - Street 1:3819 STEPHENS AVE STE 300
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801
Practice Address - Country:US
Practice Address - Phone:406-215-2225
Practice Address - Fax:406-215-2226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-16
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty