Healthcare Provider Details

I. General information

NPI: 1417366576
Provider Name (Legal Business Name): DR. RHONDA EICKHOLT MHAPRN P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2014
Last Update Date: 08/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3972 US HIGHWAY 93 N SUITE C
STEVENSVILLE MT
59870-6494
US

IV. Provider business mailing address

3972 US HIGHWAY 93 N SUITE C
STEVENSVILLE MT
59870-6494
US

V. Phone/Fax

Practice location:
  • Phone: 406-777-6958
  • Fax: 406-777-5869
Mailing address:
  • Phone: 406-777-6958
  • Fax: 406-777-5869

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberMT37331
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License NumberMT37331
License Number StateMT

VIII. Authorized Official

Name: RHONDA MAE EICKHOLT
Title or Position: OWNER
Credential: MHAPRN
Phone: 406-777-6958