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General NPI Number Information
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NPI Number | 1487478921
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Entity Type | Individual
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Provider Name | BECKY PEDERSON PCLC, ACLC
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Gender | Female
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Dates
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Enumeration Date | 11/12/2024
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Last Update Date | 11/12/2024
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Provider Practice Location Address
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Address Line | 113 W MAIN ST
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City | HALL
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State | MT
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Zip | 59837-9709
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Country | US
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Telephone | 406-529-2146
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Fax |
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Provider Business Mailing Address
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Address Line | 113 W MAIN ST
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City | HALL
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State | MT
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Zip | 59837-9709
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Country | US
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Telephone | 406-529-2146
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | BBH-ACLC-LIC-72917
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License Number State | MT
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | BBH-PCLC-LIC-72629
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License Number State | MT
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