Healthcare Provider Details

I. General information

NPI: 1801621966
Provider Name (Legal Business Name): BROOKE OLIVIA BEIGHLE MA, PCLC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2024
Last Update Date: 09/06/2024
Certification Date: 09/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2721 CONNERY WAY
MISSOULA MT
59808-1951
US

IV. Provider business mailing address

2721 CONNERY WAY
MISSOULA MT
59808-1951
US

V. Phone/Fax

Practice location:
  • Phone: 406-219-1267
  • Fax: 855-975-3095
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberBBH-PCLC-LIC-72524
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: