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General NPI Number Information
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NPI Number | 1972055267
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Entity Type | Organization
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Legal Business Name | FAMILY WORKS FOR KIDS PLLP
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Dates
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Enumeration Date | 11/02/2016
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Last Update Date | 11/02/2016
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Provider Practice Location Address
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Address Line | 1523 WYOMING AVE
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City | BILLINGS
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State | MT
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Zip | 59102-4105
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Country | US
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Telephone | 406-672-6201
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Fax |
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Provider Business Mailing Address
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Address Line | 1523 WYOMING AVE
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City | BILLINGS
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State | MT
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Zip | 59102-4105
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Country | US
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Telephone | 406-672-6201
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Fax |
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Authorized Official
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Title or Position | NEUROPSYCHOLOGIST GENERAL PARTNER
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Name | DR. BRENDA KAY ROCHE
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Credential | PHD
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Telephone | 406-672-6201
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 357
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License Number State | MT
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