Healthcare Provider Details

I. General information

NPI: 1669296422
Provider Name (Legal Business Name): ONE LOVE FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2024
Last Update Date: 11/08/2024
Certification Date: 11/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 E BROADWAY ST STE 23
MISSOULA MT
59802-4567
US

IV. Provider business mailing address

9 SEPTEMBER DR
MISSOULA MT
59802-3321
US

V. Phone/Fax

Practice location:
  • Phone: 406-823-0176
  • Fax:
Mailing address:
  • Phone: 406-549-6808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY A APRYLE
Title or Position: DIRECTOR
Credential:
Phone: 406-549-6808