Healthcare Provider Details

I. General information

NPI: 1740699875
Provider Name (Legal Business Name): LISA MATOVICH-BROOKE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2014
Last Update Date: 08/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4180 IRON HORSE TRL
BILLINGS MT
59106-9645
US

IV. Provider business mailing address

4180 IRON HORSE TRL
BILLINGS MT
59106-9645
US

V. Phone/Fax

Practice location:
  • Phone: 406-672-7904
  • Fax:
Mailing address:
  • Phone: 406-672-7904
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number554
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: