Healthcare Provider Details

I. General information

NPI: 1750194528
Provider Name (Legal Business Name): JASON CHRISTOPHER MILLS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2025
Last Update Date: 01/27/2025
Certification Date: 01/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 1ST AVE W STE 210
KALISPELL MT
59901-5607
US

IV. Provider business mailing address

327 3RD ST E
KALISPELL MT
59901-4519
US

V. Phone/Fax

Practice location:
  • Phone: 406-607-4900
  • Fax:
Mailing address:
  • Phone: 412-651-8840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberBBH-PCLC-LIC-70076
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: