Healthcare Provider Details

I. General information

NPI: 1508313685
Provider Name (Legal Business Name): SPIRITHORSE EQUINE ASSISTED THERAPIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2016
Last Update Date: 09/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33578 CANYON VIEW DR
SAINT IGNATIUS MT
59865-9748
US

IV. Provider business mailing address

PO BOX 709
RONAN MT
59864-0709
US

V. Phone/Fax

Practice location:
  • Phone: 406-239-4274
  • Fax:
Mailing address:
  • Phone: 406-546-7497
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number815
License Number StateMT

VIII. Authorized Official

Name: SHIRLEY ANN BUTLER
Title or Position: MENTAL HEALTH SPECIALIST
Credential: LCSW
Phone: 406-546-7497