Healthcare Provider Details

I. General information

NPI: 1851171631
Provider Name (Legal Business Name): INNER BELONGING THERAPY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2023
Last Update Date: 10/04/2023
Certification Date: 10/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2066 STADIUM DR STE 201
BOZEMAN MT
59715-0640
US

IV. Provider business mailing address

PO BOX 11021
BOZEMAN MT
59719-1021
US

V. Phone/Fax

Practice location:
  • Phone: 406-730-7836
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CANDACE MCMANN
Title or Position: LICENSED COUNSELOR
Credential: LCPC
Phone: 406-730-7836