Healthcare Provider Details

I. General information

NPI: 1205654209
Provider Name (Legal Business Name): INNER JOURNEY HEALTHCARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2024
Last Update Date: 03/06/2025
Certification Date: 03/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 HICKORY ST STE 1
MISSOULA MT
59801-1896
US

IV. Provider business mailing address

121 HICKORY ST STE 4
MISSOULA MT
59801-1896
US

V. Phone/Fax

Practice location:
  • Phone: 406-296-5071
  • Fax:
Mailing address:
  • Phone: 406-541-2012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. JOEY BANKS
Title or Position: MEDICAL DIRECTORY
Credential: MD
Phone: 406-296-5071