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General NPI Number Information
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NPI Number | 1114293354
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Entity Type | Organization
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Legal Business Name | ALEMBIC PSYCHOTHERAPY INCORPORATED
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Dates
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Enumeration Date | 03/30/2012
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Last Update Date | 06/15/2012
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Provider Practice Location Address
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Address Line | 725 W ALDER ST STE. 28
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City | MISSOULA
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State | MT
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Zip | 59802-4026
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Country | US
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Telephone | 406-728-4791
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Fax | 406-728-4791
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Provider Business Mailing Address
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Address Line | 3505 W FORK PETTY CREEK RD
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City | ALBERTON
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State | MT
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Zip | 59820-9313
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Country | US
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Telephone | 406-728-4791
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Fax | 406-728-4791
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. VICTOR STAMPLEY
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Credential | LCSW
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Telephone | 406-728-4791
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 162LCSW
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License Number State | MT
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