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General NPI Number Information
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NPI Number | 1598684433
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Entity Type | Organization
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Legal Business Name | THE MERIDIAN THERAPY GROUP
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Dates
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Enumeration Date | 07/14/2026
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Last Update Date | 07/14/2026
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Provider Practice Location Address
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Address Line | 113 E OAK ST STE OFFICE7
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City | BOZEMAN
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State | MT
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Zip | 59715-2970
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Country | US
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Telephone | 406-209-4928
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 10542
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City | BOZEMAN
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State | MT
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Zip | 59719-0542
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Country | US
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Telephone | 406-209-4928
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Fax |
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Authorized Official
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Title or Position | PARTIAL OWNER/PSYCHOTHERAPIST
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Name | MACKENZIE FULLETON
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Credential | LCSW
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Telephone | 406-209-4928
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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 |
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License Number State |
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