Healthcare Provider Details

I. General information

NPI: 1144591769
Provider Name (Legal Business Name): PHILIP A HOUSE, PSY D, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2012
Last Update Date: 01/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1629 AVENUE D BLDG B, STE 2
BILLINGS MT
59102-3042
US

IV. Provider business mailing address

PO BOX 22098
BILLINGS MT
59104-2098
US

V. Phone/Fax

Practice location:
  • Phone: 406-245-4446
  • Fax:
Mailing address:
  • Phone: 406-245-4446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number270
License Number StateMT

VIII. Authorized Official

Name: DR. PHILIP A HOUSE
Title or Position: OWNER
Credential: PSY D
Phone: 406-245-4446