Healthcare Provider Details

I. General information

NPI: 1851055941
Provider Name (Legal Business Name): MONTANA STATE UNIVERSITY BILLINGS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2021
Last Update Date: 10/26/2021
Certification Date: 10/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 UNIVERSITY DRIVE MSUB/COE/MCIE #174
BILLINGS MT
59101-0245
US

IV. Provider business mailing address

1500 UNIVERSITY DRIVE MSUB/COE/MCIE #174
BILLINGS MT
59101-0245
US

V. Phone/Fax

Practice location:
  • Phone: 406-657-2323
  • Fax: 406-657-2313
Mailing address:
  • Phone: 406-657-2323
  • Fax: 406-657-2313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0008X
TaxonomyPediatric Neurodevelopmental Disabilities Physician
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name: MS. KRYSTIN HUSSAIN
Title or Position: PROGRAM DIRECTOR
Credential: MS. BCBA
Phone: 406-657-2354