Healthcare Provider Details

I. General information

NPI: 1013961671
Provider Name (Legal Business Name): MONTANA NEUROBEHAVIORAL SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 02/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 N ORANGE ST THIRD FLOOR
MISSOULA MT
59802-2998
US

IV. Provider business mailing address

900 N ORANGE ST THIRD FLOOR
MISSOULA MT
59802-2998
US

V. Phone/Fax

Practice location:
  • Phone: 406-327-3350
  • Fax: 406-327-3390
Mailing address:
  • Phone: 406-327-3370
  • Fax: 406-327-3390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: LAURA K LUNDIN
Title or Position: CHIEF FINANCIAL OFFICER
Credential: BSA
Phone: 406-327-3371