Healthcare Provider Details

I. General information

NPI: 1629981238
Provider Name (Legal Business Name): PATRICK ANDREW REGIMBAL LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 CENTRAL AVE STE 408
GREAT FALLS MT
59401-3141
US

IV. Provider business mailing address

1410 15TH ST S
GREAT FALLS MT
59405-4709
US

V. Phone/Fax

Practice location:
  • Phone: 406-205-3433
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberBBH-LAC-LIC-80899
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: