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General NPI Number Information
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NPI Number | 1760644470
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Entity Type | Individual
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Provider Name | LAURA SANTA THUM LP
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Gender | Female
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Dates
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Enumeration Date | 06/25/2008
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Last Update Date | 11/04/2018
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Provider Practice Location Address
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Address Line | 502 S 19TH AVE
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City | BOZEMAN
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State | MT
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Zip | 59718-4055
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Country | US
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Telephone | 315-783-7374
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Fax |
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Provider Business Mailing Address
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Address Line | 280 W KAGY BLVD STE D126
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City | BOZEMAN
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State | MT
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Zip | 59715-6056
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Country | US
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Telephone | 406-210-6964
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY-PSY-LIC-2507
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License Number State | MT
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