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1366295180
GERALD BRENT RUDOLPH
BOZEMAN, MT
NPI
1366295180
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: MT BBH-LAC-LIC-70217)
Enumeration Date
2024-04-10
Last Update Date
2024-05-21
Business Address
GERALD BRENT RUDOLPH LAC
2216 BOOTHILL CT STE 3
BOZEMAN, MT 59715-7215
Phone number: 406-600-5007
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Mailing Address
GERALD BRENT RUDOLPH LAC
2216 BOOTHILL CT STE 3
BOZEMAN, MT 59715-7215
Phone number: 406-600-5007
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