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General NPI Number Information
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NPI Number | 1700559101
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Entity Type | Individual
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Provider Name | RIVER GERARD SEGAR CBHPSS
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Gender | Male
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Dates
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Enumeration Date | 07/30/2021
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Last Update Date | 10/26/2021
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Provider Practice Location Address
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Address Line | 202 BROOKS ST STE 300
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City | MISSOULA
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State | MT
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Zip | 59801-4019
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Country | US
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Telephone | 406-926-1453
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Fax | 406-926-1454
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Provider Business Mailing Address
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Address Line | 6860 DONOVAN CREEK RD
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City | CLINTON
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State | MT
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Zip | 59825-9745
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Country | US
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Telephone | 406-529-2522
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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 | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number | BBH-BHPS-CRT-49018
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License Number State | MT
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