Healthcare Provider Details

I. General information

NPI: 1922881663
Provider Name (Legal Business Name): ELDER TREE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2023
Last Update Date: 08/16/2023
Certification Date: 08/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 BROADWAY ST
TOWNSEND MT
59644-2223
US

IV. Provider business mailing address

132 S OAK ST
TOWNSEND MT
59644-2604
US

V. Phone/Fax

Practice location:
  • Phone: 406-813-1559
  • Fax: 406-302-0901
Mailing address:
  • Phone: 406-813-1559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: AUBREY HANCOCK
Title or Position: OWNER/MANAGER
Credential: MSW, LCSW
Phone: 406-813-1559