Provider Demographics
NPI:1740476225
Name:MONTANA NEUROPSYCHOLOGICAL CORPORATION PC
Entity type:Organization
Organization Name:MONTANA NEUROPSYCHOLOGICAL CORPORATION PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NEUROPSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:VERRILL
Authorized Official - Last Name:ENGLISH
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:406-457-5488
Mailing Address - Street 1:7 W 6TH AVE STE 607
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-5036
Mailing Address - Country:US
Mailing Address - Phone:406-457-5488
Mailing Address - Fax:406-204-0217
Practice Address - Street 1:7 W 6TH AVE STE 4G
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-5072
Practice Address - Country:US
Practice Address - Phone:406-457-5488
Practice Address - Fax:406-457-5488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-19
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TC0700X
MT261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0492507Medicaid
MT000052331OtherBLUECROSS