Healthcare Provider Details

I. General information

NPI: 1205600509
Provider Name (Legal Business Name): LEANNA TROESH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2023
Last Update Date: 11/08/2023
Certification Date: 11/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2282 US HIGHWAY 93 S
KALISPELL MT
59901-8499
US

IV. Provider business mailing address

310 ROCKY WOODS LN
BIGFORK MT
59911-6324
US

V. Phone/Fax

Practice location:
  • Phone: 406-890-2570
  • Fax:
Mailing address:
  • Phone: 808-283-3222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberBBH-ACLC-LIC-63454
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: