Healthcare Provider Details

I. General information

NPI: 1245095090
Provider Name (Legal Business Name): SACRED PATHWAYS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2024
Last Update Date: 04/18/2024
Certification Date: 04/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 S 44TH ST W APT 6205
BILLINGS MT
59106-3960
US

IV. Provider business mailing address

610 S 44TH ST W APT 6205
BILLINGS MT
59106-3960
US

V. Phone/Fax

Practice location:
  • Phone: 469-831-7327
  • Fax:
Mailing address:
  • Phone: 469-831-7327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: LINDSAY MARIE MASQUAT YELLOW ROBE
Title or Position: MENTAL HEALTH THERAPIST
Credential: LCSW
Phone: 469-831-7327