Healthcare Provider Details

I. General information

NPI: 1164331104
Provider Name (Legal Business Name): NATHAN KLETTE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 N CALIFORNIA ST
MISSOULA MT
59802-3913
US

IV. Provider business mailing address

550 N CALIFORNIA ST
MISSOULA MT
59802-3913
US

V. Phone/Fax

Practice location:
  • Phone: 406-721-2704
  • Fax: 406-721-0034
Mailing address:
  • Phone: 406-721-2704
  • Fax: 406-721-0034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberBBH-SWLC-REN-86693
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: