Healthcare Provider Details

I. General information

NPI: 1205967007
Provider Name (Legal Business Name): ANDROES & ANDROES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 03/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

465 LEISURE DR
KALISPELL MT
59901-7587
US

IV. Provider business mailing address

PO BOX 3277
KALISPELL MT
59903-3277
US

V. Phone/Fax

Practice location:
  • Phone: 406-752-3413
  • Fax: 406-752-7062
Mailing address:
  • Phone: 406-752-3413
  • Fax: 406-752-7062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number008385
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number34
License Number StateMT

VIII. Authorized Official

Name: HERMAN J ANDROES
Title or Position: GENERAL PARTNER
Credential:
Phone: 406-752-3413