MEDICARE: UNDAUNTED JOURNEY PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1073325122
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNDAUNTED JOURNEY PLLC

Provider Business Mailing Address
First Line	:	3015 10TH AVE N
Second Line	:
City	:	BILLINGS
State	:	MT
Zip	:	59101-0723
Country	:	US
Telephone Number	:	406-998-7244
Fax Number	:	406-534-9988

Provider Business Practice Location Address
First Line	:	208 N BROADWAY STE 313
Second Line	:
City	:	BILLINGS
State	:	MT
Zip	:	59101-1942
Country	:	US
Telephone Number	:	406-998-7244
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SHELLY ELLISON
Credential	:	LCSW
Telephone Number	:	406-998-7244

Provider Enumeration Date	:	01/24/2025
Last Update Date	:	01/24/2025

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