Provider Demographics
NPI:1518438415
Name:BUFFALO HEART HEALING
Entity Type:Organization
Organization Name:BUFFALO HEART HEALING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:BRENNA RAE
Authorized Official - Middle Name:
Authorized Official - Last Name:LOVE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:406-493-5423
Mailing Address - Street 1:415 N HIGGINS AVE STE 111A
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802-4561
Mailing Address - Country:US
Mailing Address - Phone:406-493-5423
Mailing Address - Fax:406-721-6901
Practice Address - Street 1:415 N HIGGINS AVE STE 111A
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-4561
Practice Address - Country:US
Practice Address - Phone:406-493-5423
Practice Address - Fax:406-721-6901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-17
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty