Organization Name: | PSYCHIATRIC CONSULTANTS OF MONTANA, PLLC |
NPI Number: | 1083053367 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DANIELLE MARIE BERTRAM (OWNER) |
Mailing Address: | 100 E Broadway St 412 Butte |
State: | MT US |
Postal Code: | 597019351 |
Phone Number: | 4064910288 |
Fax Number: | 4062993339 |
NPI Enumeration Date: | 06/19/2013 |
NPI Last Update Date: | 06/19/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LP0808X |
License Number: | NURRNLIC67645 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MT |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Psych/Mental Health |
Taxonomy Definition: |