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General NPI Number Information
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NPI Number | 1033836903
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Entity Type | Individual
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Provider Name | FAITH ELLIS
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Gender | Female
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Dates
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Enumeration Date | 10/21/2022
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Last Update Date | 09/03/2024
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Provider Practice Location Address
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Address Line | 115 W KAGY BLVD STE I
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City | BOZEMAN
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State | MT
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Zip | 59715-6043
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Country | US
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Telephone | 406-404-6752
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Fax |
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Provider Business Mailing Address
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Address Line | 1316 DEEP WELL RD
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City | STEVENSVILLE
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State | MT
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Zip | 59870-6946
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Country | US
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Telephone | 406-370-8886
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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