Healthcare Provider Details

I. General information

NPI: 1508741372
Provider Name (Legal Business Name): SERRA HURST BAMS, NMT
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2025
Last Update Date: 08/09/2025
Certification Date: 08/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 N HIGGINS AVE STE 204
MISSOULA MT
59802-4457
US

IV. Provider business mailing address

41338 FLASHS HONOR LN
GREENOUGH MT
59823-9660
US

V. Phone/Fax

Practice location:
  • Phone: 406-830-9127
  • Fax:
Mailing address:
  • Phone: 406-830-9127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number9083
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: