Healthcare Provider Details

I. General information

NPI: 1790602332
Provider Name (Legal Business Name): AMANDA TRIPP JOHANSSON PCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2026
Last Update Date: 07/04/2026
Certification Date: 07/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 KENSINGTON AVE STE 14
MISSOULA MT
59801-5700
US

IV. Provider business mailing address

429 WHITEWATER LN
ALBERTON MT
59820-8514
US

V. Phone/Fax

Practice location:
  • Phone: 970-501-5226
  • Fax:
Mailing address:
  • Phone: 970-501-5226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberBBH-PCLC-LIC-89083
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberBBH-PCLC-LIC-89083
License Number StateMT
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberBBH-PCLC-LIC-89083
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: