Healthcare Provider Details

I. General information

NPI: 1093847865
Provider Name (Legal Business Name): WOMENS COUNSELING CENTER P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SOUTH AVE W # A
MISSOULA MT
59801-7804
US

IV. Provider business mailing address

35510 EDS CREEK RD
ALBERTON MT
59820-9441
US

V. Phone/Fax

Practice location:
  • Phone: 406-728-8388
  • Fax:
Mailing address:
  • Phone: 406-728-8388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number473
License Number StateMT

VIII. Authorized Official

Name: GUS ADAMS
Title or Position: OFFICE MANAGER
Credential:
Phone: 406-864-2808