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General NPI Number Information
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NPI Number | 1801782164
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Entity Type | Organization
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Legal Business Name | MISSOULA BEHAVIORAL CONSULTING, PLLC
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Dates
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Enumeration Date | 06/14/2025
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Last Update Date | 06/14/2025
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Provider Practice Location Address
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Address Line | 2115 TRAIL ST
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City | MISSOULA
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State | MT
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Zip | 59801-1537
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Country | US
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Telephone | 406-491-7450
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Fax |
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Provider Business Mailing Address
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Address Line | 2115 TRAIL ST
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City | MISSOULA
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State | MT
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Zip | 59801-1537
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Country | US
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Telephone | 406-491-7450
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Fax |
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Authorized Official
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Title or Position | BOARD CERTIFIED BEHAVIOR ANALYST
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Name | JOLYNN BLAKELEY
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Credential | BCBA, LBA
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Telephone | 406-491-7450
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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