Healthcare Provider Details

I. General information

NPI: 1750204525
Provider Name (Legal Business Name): NORTHERN LIGHTS MENTAL HEALTH COLLECTIVE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

642 RED BARN DR
BELGRADE MT
59714-7206
US

IV. Provider business mailing address

642 RED BARN DR
BELGRADE MT
59714-7206
US

V. Phone/Fax

Practice location:
  • Phone: 406-546-2915
  • Fax:
Mailing address:
  • Phone: 406-546-2915
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MARNIE BASTA-SMITH
Title or Position: APRN
Credential: PMHNP-BC
Phone: 406-546-2915