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General NPI Number Information
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NPI Number | 1841437142
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Entity Type | Organization
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Legal Business Name | GLACIER PSYCHOLOGICAL SERVICES LLC
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Dates
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Enumeration Date | 01/08/2009
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Last Update Date | 01/21/2009
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Provider Practice Location Address
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Address Line | 723 5TH AVE E SUITE 126S
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City | KALISPELL
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State | MT
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Zip | 59901-5321
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Country | US
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Telephone | 406-253-7745
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Fax | 406-257-9721
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Provider Business Mailing Address
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Address Line | 723 5TH AVE E SUITE 126S
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City | KALISPELL
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State | MT
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Zip | 59901-5321
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Country | US
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Telephone | 406-253-7745
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Fax | 406-257-9721
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | DR. JENNIFER ANNE SIMON-THOMAS
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Credential | PH.D.
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Telephone | 406-253-7745
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 355
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License Number State | MT
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