| NPI | 1013469410 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CORIE GOULD Owner/Licensed Psychologist 406-698-2722 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 6301016590) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: MI 6301016590) |
| Enumeration Date | 2016-11-01 |
| Last Update Date | 2016-11-01 |