| NPI | 1063567493 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANE LYNN SULLIVAN Business Manager 406-861-6389 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MT 192) |
| Enumeration Date | 2007-01-24 |
| Last Update Date | 2018-09-06 |