Healthcare Provider Details

I. General information

NPI: 1104667500
Provider Name (Legal Business Name): PAINTED HILLS PSYCHIATRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2024
Last Update Date: 09/12/2025
Certification Date: 09/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1807 W DICKERSON ST STE D
BOZEMAN MT
59715-1311
US

IV. Provider business mailing address

3701 TRAKKER TRL STE 1B
BOZEMAN MT
59718-9202
US

V. Phone/Fax

Practice location:
  • Phone: 406-404-7384
  • Fax: 406-284-0619
Mailing address:
  • Phone: 406-404-7384
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MARY COOK
Title or Position: OWNER
Credential: NP
Phone: 406-539-5500