Provider Demographics
NPI:1700402302
Name:TREE OF LIFE THERAPY CENTER, P.C.
Entity Type:Organization
Organization Name:TREE OF LIFE THERAPY CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:KATHLEEN
Authorized Official - Last Name:BUCK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:406-647-4817
Mailing Address - Street 1:PO BOX 22796
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59104-2796
Mailing Address - Country:US
Mailing Address - Phone:406-647-4817
Mailing Address - Fax:
Practice Address - Street 1:547 S 20TH ST W STE 5
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-6445
Practice Address - Country:US
Practice Address - Phone:406-647-4817
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-19
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty