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General NPI Number Information
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NPI Number | 1154211852
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Entity Type | Organization
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Legal Business Name | SHADOWLANDS COUPLES THERAPY, PLLC
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Dates
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Enumeration Date | 07/07/2025
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Last Update Date | 07/07/2025
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Provider Practice Location Address
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Address Line | 115 W KAGY BLVD STE O
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City | BOZEMAN
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State | MT
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Zip | 59715-6026
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Country | US
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Telephone | 406-414-6774
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1383
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City | BELGRADE
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State | MT
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Zip | 59714-1383
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MARIA COSTA
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Credential | LMFT
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Telephone | 406-414-6774
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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