Healthcare Provider Details

I. General information

NPI: 1427758473
Provider Name (Legal Business Name): TREE OF LIFE DOULA CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2023
Last Update Date: 03/08/2023
Certification Date: 03/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 W MENDENHALL ST
BOZEMAN MT
59715-3446
US

IV. Provider business mailing address

PO BOX 1095
MANHATTAN MT
59741-1095
US

V. Phone/Fax

Practice location:
  • Phone: 406-200-8548
  • Fax:
Mailing address:
  • Phone: 406-579-8157
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateNULL

VIII. Authorized Official

Name: KELLI STANLEY
Title or Position: OWNER
Credential:
Phone: 406-579-8157