Provider Demographics
NPI:1669642393
Name:CHILD DEVELOPMENT CENTER, INC
Entity Type:Organization
Organization Name:CHILD DEVELOPMENT CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE SERVICES ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:GILCHRIST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-549-6413
Mailing Address - Street 1:3335 LT MOSS RD
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59804-7222
Mailing Address - Country:US
Mailing Address - Phone:406-549-6413
Mailing Address - Fax:406-542-0143
Practice Address - Street 1:3335 LT MOSS RD
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59804-7222
Practice Address - Country:US
Practice Address - Phone:406-549-6413
Practice Address - Fax:406-542-0143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-10
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X, 251S00000X, 252Y00000X
MT252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT100030754Medicaid