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General NPI Number Information
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NPI Number | 1508380841
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Entity Type | Organization
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Legal Business Name | NORTH MOUNTAIN WELLNESS GROUP
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Dates
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Enumeration Date | 07/28/2017
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Last Update Date | 11/22/2017
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Provider Practice Location Address
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Address Line | 1500 POLY DR
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City | BILLINGS
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State | MT
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Zip | 59102-1748
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Country | US
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Telephone | 406-794-4190
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Fax |
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Provider Business Mailing Address
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Address Line | 4409 PINE COVE RD
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City | BILLINGS
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State | MT
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Zip | 59106-1334
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Country | US
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Telephone | 406-794-4190
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. BRENT CARPENTER
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Credential | LCSW
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Telephone | 406-794-4190
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | BBH-LCSW-LIC-18808
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License Number State | MT
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | BBH-LCSW-LIC-7367
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License Number State | MT
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