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General NPI Number Information
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NPI Number | 1760902886
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Entity Type | Individual
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Provider Name | PATTY SISK GOODMUNDSON
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Gender | Female
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Dates
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Enumeration Date | 06/20/2017
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Last Update Date | 11/18/2019
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Provider Practice Location Address
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Address Line | 225 7TH AVE S
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City | GREAT FALLS
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State | MT
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Zip | 59405-1820
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Country | US
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Telephone | 406-453-5592
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Fax |
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Provider Business Mailing Address
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Address Line | 100 1ST ST SE
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City | DUTTON
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State | MT
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Zip | 59433-9665
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Country | US
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Telephone | 406-788-4706
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Fax | 406-952-4555
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State | MT
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