Healthcare Provider Details

I. General information

NPI: 1790623296
Provider Name (Legal Business Name): SIERRA GRACE LEE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 W KOCH ST STE 5
BOZEMAN MT
59715-1301
US

IV. Provider business mailing address

1800 W KOCH ST STE 5
BOZEMAN MT
59715-1301
US

V. Phone/Fax

Practice location:
  • Phone: 406-219-8055
  • Fax:
Mailing address:
  • Phone: 240-277-7626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberBBH-LCPC-88496
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: