Healthcare Provider Details

I. General information

NPI: 1255676334
Provider Name (Legal Business Name): GABRIELLE N MOLINA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2012
Last Update Date: 07/10/2024
Certification Date: 07/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1924 W STEVENS ST STE 202
BOZEMAN MT
59718-7043
US

IV. Provider business mailing address

1924 W STEVENS ST STE 202
BOZEMAN MT
59718-7043
US

V. Phone/Fax

Practice location:
  • Phone: 406-595-3746
  • Fax: 406-578-1363
Mailing address:
  • Phone: 406-595-3746
  • Fax: 406-578-1363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: