Provider Demographics
NPI:1205249463
Name:BIG SKY PSYCHOLOGICAL CONSORTIUM, PLLC
Entity type:Organization
Organization Name:BIG SKY PSYCHOLOGICAL CONSORTIUM, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:CATHERINE
Authorized Official - Last Name:MCKINNIE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:406-582-1321
Mailing Address - Street 1:1648 ELLIS ST STE 302
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-8811
Mailing Address - Country:US
Mailing Address - Phone:406-582-1321
Mailing Address - Fax:406-587-1513
Practice Address - Street 1:1648 ELLIS ST STE 302
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-8811
Practice Address - Country:US
Practice Address - Phone:406-582-1321
Practice Address - Fax:406-587-1513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-05
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT338103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty