Provider Demographics
NPI:1417318023
Name:MONTANA NEUROPSYCHOLOGICAL ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:MONTANA NEUROPSYCHOLOGICAL ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:BLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-543-9700
Mailing Address - Street 1:1622 SOUTH AVE W
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-7804
Mailing Address - Country:US
Mailing Address - Phone:406-543-9700
Mailing Address - Fax:406-549-8109
Practice Address - Street 1:1622 SOUTH AVE W
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-7804
Practice Address - Country:US
Practice Address - Phone:406-543-9700
Practice Address - Fax:406-549-8109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-09
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty