MEDICARE: EMILY GRILLS

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-LCPC-LIC-55997	MT
2	106S00000X	Behavior Technician	17-45999	MT

General Provider Information

NPI Number	:	1528568565
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY GRILLS

Provider Business Mailing Address
First Line	:	2023 STADIUM DR STE 2A
Second Line	:
City	:	BOZEMAN
State	:	MT
Zip	:	59715-0613
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2023 STADIUM DR STE 2A
Second Line	:
City	:	BOZEMAN
State	:	MT
Zip	:	59715-0613
Country	:	US
Telephone Number	:	406-587-2477
Fax Number	:

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

Provider Enumeration Date	:	02/16/2018
Last Update Date	:	03/02/2026

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Directions to “ EMILY GRILLS ” Practice Location

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