Healthcare Provider Details

I. General information

NPI: 1336649011
Provider Name (Legal Business Name): MOLLY MURPHY COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2018
Last Update Date: 02/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 FAIRVIEW AVE STE 240
MISSOULA MT
59801-7821
US

IV. Provider business mailing address

4216 23RD AVE
MISSOULA MT
59803-1147
US

V. Phone/Fax

Practice location:
  • Phone: 406-370-6696
  • Fax:
Mailing address:
  • Phone: 406-370-6696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberBBH-LCPC-LIC-17294
License Number State

VIII. Authorized Official

Name: MOLLY K MURPHY
Title or Position: COUNSELOR
Credential: LCPC
Phone: 406-370-6696