Healthcare Provider Details

I. General information

NPI: 1942287891
Provider Name (Legal Business Name): FACILITATING LIFE CHANGES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2005
Last Update Date: 01/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 W SPRUCE ST
MISSOULA MT
59802
US

IV. Provider business mailing address

PO BOX 1328 FLC INC OR CUSTOM MEDICAL BILLING
FLORENCE MT
59833
US

V. Phone/Fax

Practice location:
  • Phone: 406-327-9697
  • Fax:
Mailing address:
  • Phone: 406-273-7600
  • Fax: 406-273-7601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number307
License Number StateMT

VIII. Authorized Official

Name: DR. DIANA L BJORGEN
Title or Position: PRESIDENT OWNER
Credential: PHD
Phone: 406-327-9697