Healthcare Provider Details

I. General information

NPI: 1275164865
Provider Name (Legal Business Name): MONTANA BEHAVIOR COLLABORATIVE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2020
Last Update Date: 02/01/2020
Certification Date: 02/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

735 E BROADWAY ST
HELENA MT
59601-4313
US

IV. Provider business mailing address

735 E BROADWAY ST
HELENA MT
59601-4313
US

V. Phone/Fax

Practice location:
  • Phone: 406-552-5762
  • Fax:
Mailing address:
  • Phone: 406-552-5762
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: TRACI SHINABARGER
Title or Position: OWNER/MANAGER
Credential: LCSW, MPA, BCBA
Phone: 406-552-5762