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General NPI Number Information
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NPI Number | 1407010317
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Entity Type | Organization
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Legal Business Name | JEANETTE STANGL INC PC
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Dates
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Enumeration Date | 07/10/2008
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Last Update Date | 09/26/2008
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Provider Practice Location Address
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Address Line | 821 SOUTH ORANGE ST SACAJAWEA OFFICES
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City | MISSOULA
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State | MT
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Zip | 59801-6724
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Country | US
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Telephone | 406-542-8461
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Fax |
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Provider Business Mailing Address
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Address Line | 415 E KENT AVE
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City | MISSOULA
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State | MT
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Zip | 59801-6021
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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 | PRESIDENT
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Name | MS. JEANETTE MARIE STANGL
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Credential | LCSW LAC
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Telephone | 406-542-8461
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 454
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License Number State | MT
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