Healthcare Provider Details

I. General information

NPI: 1538891486
Provider Name (Legal Business Name): CHRISTALIE KUGLIN PCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2022
Last Update Date: 06/29/2022
Certification Date: 06/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 WEST OAK STREET SUITE 205 BLDG B
BOZEMAN MT
59715-5971
US

IV. Provider business mailing address

1001 OAK ST STE 205 BUILDING B
BOZEMAN MT
59715-8757
US

V. Phone/Fax

Practice location:
  • Phone: 406-599-2492
  • Fax:
Mailing address:
  • Phone: 406-599-2492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberBBH-PCLC-LIC-50260
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: