Healthcare Provider Details

I. General information

NPI: 1588291363
Provider Name (Legal Business Name): ASTA PAULSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2020
Last Update Date: 01/26/2023
Certification Date: 01/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 MAIN STREET
MILES CITY MT
59301-3037
US

IV. Provider business mailing address

1100 MAIN STREET
MILES CITY MT
59301-3037
US

V. Phone/Fax

Practice location:
  • Phone: 406-220-5060
  • Fax: 406-306-0024
Mailing address:
  • Phone: 406-220-5060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberBBH-LCPC-LIC-42772
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberBBH-LCPC-LIC-42772
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: