Provider Demographics
NPI:1891400537
Name:ISELY, AMBROSIA (LCSW, ACLC)
Entity Type:Individual
Prefix:
First Name:AMBROSIA
Middle Name:
Last Name:ISELY
Suffix:
Gender:F
Credentials:LCSW, ACLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 W ALDER ST STE 22
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802-4026
Mailing Address - Country:US
Mailing Address - Phone:406-750-6899
Mailing Address - Fax:
Practice Address - Street 1:725 W ALDER ST STE 22
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-4026
Practice Address - Country:US
Practice Address - Phone:406-750-6899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-17
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LCSW-LIC-622331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical