=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790602332
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AMANDA TRIPP JOHANSSON PCLC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/03/2026
-----------------------------------------------------
Last Update Date | 07/04/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 715 KENSINGTON AVE STE 14
-----------------------------------------------------
City | MISSOULA
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59801-5700
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-501-5226
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 429 WHITEWATER LN
-----------------------------------------------------
City | ALBERTON
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59820-8514
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-501-5226
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | BBH-PCLC-LIC-89083
-----------------------------------------------------
License Number State | MT
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number | BBH-PCLC-LIC-89083
-----------------------------------------------------
License Number State | MT
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | BBH-PCLC-LIC-89083
-----------------------------------------------------
License Number State | MT
-----------------------------------------------------