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NPI Code Detail

MEDICARE: GABRIELLE HERRON-TAMMETTA PCLC

MEDICARE: GABRIELLE HERRON-TAMMETTA PCLC
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
1101YM0800XMental Health CounselorBBH-PCLC-LIC-71405MT

General Provider Information

NPI Number : 1427893601
Entity Type Code : Individual
Provider Name (Legal Business Name) : GABRIELLE HERRON-TAMMETTA PCLC
Provider Business Mailing Address
First Line : 950 STONERIDGE DR STE 1
Second Line :
City : BOZEMAN
State : MT
Zip : 59718-7063
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 950 STONERIDGE DR STE 1
Second Line :
City : BOZEMAN
State : MT
Zip : 59718-7063
Country : US
Telephone Number : 406-570-1424
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/28/2024
Last Update Date : 06/28/2024

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