Healthcare Provider Details

I. General information

NPI: 1548173016
Provider Name (Legal Business Name): MOUNTAIN BLUEBIRD PSYCHIATRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2224 US HIGHWAY 87 E TRLR 14
BILLINGS MT
59101-6601
US

IV. Provider business mailing address

2224 US HIGHWAY 87 E TRLR 14
BILLINGS MT
59101-6601
US

V. Phone/Fax

Practice location:
  • Phone: 406-208-4450
  • Fax:
Mailing address:
  • Phone: 406-208-4450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: EMMALINE SUE JACKSON
Title or Position: PMHNP
Credential: NP
Phone: 406-208-4450