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General NPI Number Information
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NPI Number | 1720539745
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Entity Type | Organization
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Legal Business Name | VALEO BEHAVIORAL HEALTH, LLC
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Dates
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Enumeration Date | 10/14/2016
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Last Update Date | 01/21/2019
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Provider Practice Location Address
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Address Line | 1600 NORTH AVE W STE 106
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City | MISSOULA
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State | MT
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Zip | 59801-5500
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Country | US
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Telephone | 406-544-7678
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Fax | 406-926-3117
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Provider Business Mailing Address
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Address Line | 1600 NORTH AVE W STE 106
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City | MISSOULA
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State | MT
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Zip | 59801-5500
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Country | US
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Telephone | 406-544-7678
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Fax | 406-926-3117
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | MRS. KRISTINA MARIE MINER
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Credential | LCSW, LAC, MSW
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Telephone | 406-544-7678
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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 | BBH-LAC-LIC-1354
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License Number State | MT
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | BBH-LCSW-LIC-999
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License Number State | MT
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