Healthcare Provider Details

I. General information

NPI: 1598684433
Provider Name (Legal Business Name): THE MERIDIAN THERAPY GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 E OAK ST STE OFFICE7
BOZEMAN MT
59715-2970
US

IV. Provider business mailing address

PO BOX 10542
BOZEMAN MT
59719-0542
US

V. Phone/Fax

Practice location:
  • Phone: 406-209-4928
  • Fax:
Mailing address:
  • Phone: 406-209-4928
  • Fax:

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: MACKENZIE FULLETON
Title or Position: PARTIAL OWNER/PSYCHOTHERAPIST
Credential: LCSW
Phone: 406-209-4928