Provider Demographics
NPI:1639962483
Name:SUB ROSA BEHAVIORAL HEALTH, PLLC
Entity type:Organization
Organization Name:SUB ROSA BEHAVIORAL HEALTH, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANN
Authorized Official - Middle Name:MAURINE
Authorized Official - Last Name:MATNEY
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:406-589-6902
Mailing Address - Street 1:1001 W OAK ST STE 205
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-8757
Mailing Address - Country:US
Mailing Address - Phone:406-589-6902
Mailing Address - Fax:406-577-2085
Practice Address - Street 1:1001 W OAK ST STE 205
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-8757
Practice Address - Country:US
Practice Address - Phone:406-589-6902
Practice Address - Fax:406-577-2085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-26
Last Update Date:2025-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)