Healthcare Provider Details

I. General information

NPI: 1346029972
Provider Name (Legal Business Name): AMY RENEE BARK LMSW-CLINICAL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2023
Last Update Date: 03/08/2024
Certification Date: 03/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

149 SHILOH RD STE 9
BILLINGS MT
59106-2775
US

IV. Provider business mailing address

149 SHILOH RD STE 9
BILLINGS MT
59106-2775
US

V. Phone/Fax

Practice location:
  • Phone: 855-593-4357
  • Fax:
Mailing address:
  • Phone: 855-593-4357
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number6801114253
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: