Healthcare Provider Details

I. General information

NPI: 1730014374
Provider Name (Legal Business Name): ELIZABETH LAIR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

72 ARROW PEAK CT
BOZEMAN MT
59718-1106
US

IV. Provider business mailing address

601 NIKLES DR STE 2E
BOZEMAN MT
59715-2588
US

V. Phone/Fax

Practice location:
  • Phone: 406-539-1254
  • Fax:
Mailing address:
  • Phone: 406-539-1254
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberBBH-PCLC-LIC-88966
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: