Healthcare Provider Details

I. General information

NPI: 1033397146
Provider Name (Legal Business Name): SOUTHWEST MONTANA NEUROPSYCHOLOGY SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2008
Last Update Date: 01/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 W PLATINUM ST STE F
BUTTE MT
59701-2200
US

IV. Provider business mailing address

PO BOX 223
WARM SPRINGS MT
59756-0223
US

V. Phone/Fax

Practice location:
  • Phone: 406-782-4597
  • Fax: 406-782-1347
Mailing address:
  • Phone: 406-693-2103
  • Fax: 406-782-1347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: AUDREY J MATTSON
Title or Position: OWNER / CLINICAL NEUROPSYCHOLOGIST
Credential: PH.D.
Phone: 406-782-4597