Healthcare Provider Details

I. General information

NPI: 1447170931
Provider Name (Legal Business Name): MICAH LYNN LEACH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 E MAIN ST STE 418
BOZEMAN MT
59715-4702
US

IV. Provider business mailing address

1241 N 12TH AVE APT 301
BOZEMAN MT
59715-4396
US

V. Phone/Fax

Practice location:
  • Phone: 406-580-8082
  • Fax:
Mailing address:
  • Phone: 406-580-8082
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberBBH-SWLC-LIC-90172
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: