Healthcare Provider Details

I. General information

NPI: 1821756404
Provider Name (Legal Business Name): BELLATHIA PSYCHIATRY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2021
Last Update Date: 04/24/2025
Certification Date: 04/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 CHASE WAY APT B
BOZEMAN MT
59718-5473
US

IV. Provider business mailing address

355 CHASE WAY APT B
BOZEMAN MT
59718-5473
US

V. Phone/Fax

Practice location:
  • Phone: 406-201-5937
  • Fax: 888-829-4791
Mailing address:
  • Phone: 406-201-5937
  • Fax: 888-829-4791

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code363LP1700X
TaxonomyPerinatal Nurse Practitioner
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateNULL

VIII. Authorized Official

Name: NICOLE MARIE FAESSEL
Title or Position: CEO
Credential: APRN
Phone: 406-201-5937