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General NPI Number Information
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NPI Number | 1154027886
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Entity Type | Organization
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Legal Business Name | RADICAL THERAPEUTICS LLC
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Dates
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Enumeration Date | 02/03/2023
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Last Update Date | 02/13/2026
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Provider Practice Location Address
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Address Line | 801 SHERWOOD STREET 112
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City | MISSOULA
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State | MT
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Zip | 59802
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Country | US
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Telephone | 406-318-5588
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Fax |
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Provider Business Mailing Address
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Address Line | 2814 BROOKS ST PMB 145
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City | MISSOULA
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State | MT
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Zip | 59801-3303
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Country | US
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Telephone | 406-318-5588
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Fax |
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Authorized Official
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Title or Position | LCSW
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Name | ELIZABETH ROSE DUBLINSKI
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Credential | LCSW
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Telephone | 480-353-1538
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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