MEDICARE: MRS. CALLIE MONROE WOODMAN MA

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	101YM0800X	Mental Health Counselor	BBH-PCLC-LIC-39115	MT

General Provider Information

NPI Number	:	1518543545
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CALLIE MONROE WOODMAN MA

Provider Business Mailing Address
First Line	:	1621 S 9TH ST W
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59801-3434
Country	:	US
Telephone Number	:	406-546-4043
Fax Number	:

Provider Business Practice Location Address
First Line	:	1621 S 9TH ST W
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59801-3434
Country	:	US
Telephone Number	:	406-546-4043
Fax Number	:

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

Provider Enumeration Date	:	03/21/2021
Last Update Date	:	03/21/2021

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