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General NPI Number Information
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NPI Number | 1265243794
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Entity Type | Individual
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Provider Name | CARLY COOK
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Gender | Female
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Dates
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Enumeration Date | 01/15/2025
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Last Update Date | 01/15/2025
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Provider Practice Location Address
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Address Line | 321 E MAIN ST
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City | BOZEMAN
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State | MT
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Zip | 59715-6241
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Country | US
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Telephone | 406-595-0230
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Fax |
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Provider Business Mailing Address
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Address Line | 3891 GALLOWAY ST
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City | BOZEMAN
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State | MT
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Zip | 59718-8029
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Country | US
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Telephone | 406-595-0230
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Fax |
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | BBH-PCLC-LIC-64334
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License Number State | MT
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