Healthcare Provider Details

I. General information

NPI: 1538335542
Provider Name (Legal Business Name): ELLEN BROXMEYER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ELLEN BAKER LCSW

II. Dates (important events)

Enumeration Date: 04/30/2008
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 E MAIN ST STE 401
BOZEMAN MT
59715-5045
US

IV. Provider business mailing address

233 E MAIN ST STE 401
BOZEMAN MT
59715-5045
US

V. Phone/Fax

Practice location:
  • Phone: 406-219-7835
  • Fax:
Mailing address:
  • Phone: 406-219-7835
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW-991738
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: