Healthcare Provider Details

I. General information

NPI: 1174448211
Provider Name (Legal Business Name): GREGORY SEAN IDDINGS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 US HIGHWAY 2 W STE A
KALISPELL MT
59901-3499
US

IV. Provider business mailing address

67 SUNSET CT
KALISPELL MT
59901-2537
US

V. Phone/Fax

Practice location:
  • Phone: 406-871-4668
  • Fax:
Mailing address:
  • Phone: 406-871-4668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberBBH-PCLC-LIC-81401
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: