| Organization Name: | EATING DISORDER CENTER OF MONTANA |
| NPI Number: | 1053751487 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JENI GOCHIN (DIRECTOR) |
| Mailing Address: | 14 S Willson Ave Suite 102 Bozeman |
| State: | MT US |
| Postal Code: | 597156232 |
| Phone Number: | 8056374900 |
| Fax Number: | 4065511209 |
| NPI Enumeration Date: | 06/29/2013 |
| NPI Last Update Date: | 11/12/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 2414 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MT |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |