Provider Demographics
NPI:1770734220
Name:GALLATIN PSYCHOTHERAPY, INC
Entity type:Organization
Organization Name:GALLATIN PSYCHOTHERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:D
Authorized Official - Last Name:WIMBERLY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:406-582-0500
Mailing Address - Street 1:1902 W DICKERSON ST STE 208
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-6852
Mailing Address - Country:US
Mailing Address - Phone:406-582-0500
Mailing Address - Fax:
Practice Address - Street 1:1902 W DICKERSON ST STE 208
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-6852
Practice Address - Country:US
Practice Address - Phone:406-582-0500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-02
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT318103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0490688Medicaid
MT051821OtherBCBS
MT051821OtherBCBS