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General NPI Number Information
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NPI Number | 1083791008
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Entity Type | Individual
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Provider Name | JAMES LEE WAHLBERG PHD
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Gender | Male
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2831 FORT MISSOULA ROAD SUITE 201
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City | MISSOULA
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State | MT
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Zip | 59804-7401
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Country | US
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Telephone | 406-728-8818
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Fax | 406-327-4552
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Provider Business Mailing Address
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Address Line | 2831 FORT MISSOULA ROAD SUITE 201
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City | MISSOULA
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State | MT
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Zip | 59804-7401
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Country | US
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Telephone | 406-728-8818
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Fax | 406-327-4552
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 109
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License Number State | MT
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