Healthcare Provider Details

I. General information

NPI: 1336320134
Provider Name (Legal Business Name): JOHN L. SANTA PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2007
Last Update Date: 11/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9705 LOST PRAIRIE RD
MARION MT
59925-9844
US

IV. Provider business mailing address

9705 LOST PRAIRIE RD
MARION MT
59925-9844
US

V. Phone/Fax

Practice location:
  • Phone: 406-858-2339
  • Fax: 406-858-2356
Mailing address:
  • Phone: 406-858-2339
  • Fax: 406-858-2356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number195
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: