Healthcare Provider Details

I. General information

NPI: 1265364863
Provider Name (Legal Business Name): TRACEY LYNN ROBECKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2026
Last Update Date: 05/30/2026
Certification Date: 05/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2066 STADIUM DR STE 202
BOZEMAN MT
59715-0640
US

IV. Provider business mailing address

115 DRIFTER DR
BOZEMAN MT
59718-7275
US

V. Phone/Fax

Practice location:
  • Phone: 406-624-9165
  • Fax:
Mailing address:
  • Phone: 360-490-2775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberBBH-PCLC-LIC-88976
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: