Healthcare Provider Details

I. General information

NPI: 1295898575
Provider Name (Legal Business Name): QUINTON RICHARD HEHN EDD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 W CENTRAL AVE SUITE 209
MISSOULA MT
59801-6867
US

IV. Provider business mailing address

725 W CENTRAL AVE SUITE 209
MISSOULA MT
59801-6867
US

V. Phone/Fax

Practice location:
  • Phone: 406-542-0900
  • Fax:
Mailing address:
  • Phone: 406-542-0900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number034
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: