Healthcare Provider Details

I. General information

NPI: 1982419149
Provider Name (Legal Business Name): TAYLOR NOELLE REESE
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2025
Last Update Date: 02/12/2025
Certification Date: 02/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

745 KNAPP ST
WOLF POINT MT
59201-1820
US

IV. Provider business mailing address

745 KNAPP ST
WOLF POINT MT
59201-1820
US

V. Phone/Fax

Practice location:
  • Phone: 406-768-3052
  • Fax:
Mailing address:
  • Phone: 406-768-3052
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberBBH-LAC-APP-77668
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: