| NPI | 1205035433 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAURA DICKERSON Member 406-752-0530 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: MT 1192 LAC) |
| Enumeration Date | 2007-07-17 |
| Last Update Date | 2016-01-27 |