Healthcare Provider Details

I. General information

NPI: 1447072913
Provider Name (Legal Business Name): TAYLOR COLLINS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2024
Last Update Date: 10/28/2024
Certification Date: 10/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2282 US HWY 93 S
KALISPELL MT
59901
US

IV. Provider business mailing address

680 ELK RIDGE ROAD
WHITEFISH MT
59937
US

V. Phone/Fax

Practice location:
  • Phone: 406-890-2570
  • Fax:
Mailing address:
  • Phone: 406-890-8783
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberBBHLACLIC71683
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: