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NPI Code Detail

MEDICARE: MARIAH LEILANI TUBBY LAC

MEDICARE: MARIAH LEILANI TUBBY LAC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) CounselorBBH-ACLC-LIC-79169MT

General Provider Information

NPI Number : 1174411524
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARIAH LEILANI TUBBY LAC
Provider Business Mailing Address
First Line : 17 N 26TH ST
Second Line :
City : BILLINGS
State : MT
Zip : 59101-2303
Country : US
Telephone Number : 406-534-4558
Fax Number :
Provider Business Practice Location Address
First Line : 1125 BROADWATER AVE
Second Line :
City : BILLINGS
State : MT
Zip : 59102-5412
Country : US
Telephone Number : 406-534-4558
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/25/2025
Last Update Date : 06/25/2025

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Directions to “ MARIAH LEILANI TUBBY LAC” Practice Location

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