Healthcare Provider Details

I. General information

NPI: 1851246839
Provider Name (Legal Business Name): BEST SELF IMAGE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2026
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 ROGERS LAKE RD STE 41
KILA MT
59920-9725
US

IV. Provider business mailing address

1315 ROGERS LAKE RD STE 41
KILA MT
59920-9725
US

V. Phone/Fax

Practice location:
  • Phone: 808-755-5225
  • Fax:
Mailing address:
  • Phone: 808-755-5225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name: TINA MARIE VOGT
Title or Position: OWNER
Credential:
Phone: 808-755-5225