| NPI | 1063250132 |
|---|---|
| Former Legal Business Name | DERREK ROSS M DIV LAC LCPC PLLC |
| Entity Type | Organization |
| Authorized Contact | KAYLA NEWTON Clinical Director 406-661-1558 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2024-07-15 |
| Last Update Date | 2026-08-12 |