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General NPI Number Information
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NPI Number | 1225347669
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Entity Type | Organization
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Legal Business Name | CAPITAL CITY CONSULTANTS PC
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Dates
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Enumeration Date | 10/04/2010
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Last Update Date | 10/04/2010
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Provider Practice Location Address
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Address Line | 4745 WAGNER PL
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City | HELENA
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State | MT
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Zip | 59601-9674
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Country | US
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Telephone | 406-442-6115
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Fax |
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Provider Business Mailing Address
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Address Line | 4745 WAGNER PL
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City | HELENA
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State | MT
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Zip | 59601-9674
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Country | US
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Telephone | 406-442-6115
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Fax |
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Authorized Official
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Title or Position | CEO/PSYCHOLOGIST
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Name | DR. DANIEL BOWMAN SMELKO JR.
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Credential | PSYD
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Telephone | 406-461-1744
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 394
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License Number State | MT
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