MEDICARE: MONTANA NEUROPSYCHOLOGICAL CORPORATION PC

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	261QM0850X	Adult Mental Health Clinic/Center		MT
2	103TC0700X	Clinical Psychologist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	000052331	OTHER	MT	BLUECROSS

General Provider Information

NPI Number	:	1740476225
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MONTANA NEUROPSYCHOLOGICAL CORPORATION PC

Provider Business Mailing Address
First Line	:	7 W 6TH AVE STE 607
Second Line	:
City	:	HELENA
State	:	MT
Zip	:	59601-5036
Country	:	US
Telephone Number	:	406-457-5488
Fax Number	:	406-204-0217

Provider Business Practice Location Address
First Line	:	7 W 6TH AVE STE 4G
Second Line	:
City	:	HELENA
State	:	MT
Zip	:	59601-5072
Country	:	US
Telephone Number	:	406-457-5488
Fax Number	:	406-457-5488

Authorized Official
Title or Position	:	NEUROPSYCHOLOGIST
Name	:	JAMES VERRILL ENGLISH
Credential	:	PSYD
Telephone Number	:	406-457-5488

Provider Enumeration Date	:	09/19/2007
Last Update Date	:	10/25/2021

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