Provider Demographics
NPI:1275164865
Name:MONTANA BEHAVIOR COLLABORATIVE, PLLC
Entity Type:Organization
Organization Name:MONTANA BEHAVIOR COLLABORATIVE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TRACI
Authorized Official - Middle Name:
Authorized Official - Last Name:SHINABARGER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, MPA, BCBA
Authorized Official - Phone:406-552-5762
Mailing Address - Street 1:735 E BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-4313
Mailing Address - Country:US
Mailing Address - Phone:406-552-5762
Mailing Address - Fax:
Practice Address - Street 1:735 E BROADWAY ST
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-4313
Practice Address - Country:US
Practice Address - Phone:406-552-5762
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-01
Last Update Date:2020-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty