MEDICARE: DR. SHANTI M PEPPER PH.D.

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	103TC1900X	Counseling Psychologist	PSY-LIC-3625	MT

General Provider Information

NPI Number	:	1437429818
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHANTI M PEPPER PH.D.

Provider Business Mailing Address
First Line	:	1174 STONERIDGE DR STE 211
Second Line	:
City	:	BOZEMAN
State	:	MT
Zip	:	59718-9850
Country	:	US
Telephone Number	:	406-200-9089
Fax Number	:

Provider Business Practice Location Address
First Line	:	1174 STONERIDGE DR STE 211
Second Line	:
City	:	BOZEMAN
State	:	MT
Zip	:	59718-9850
Country	:	US
Telephone Number	:	406-200-9089
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/03/2012
Last Update Date	:	12/12/2022

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