# MOUNTAIN SAGE ACUPUNCTURE PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1720686736
- **Authorized official:** HEATHER INGE ELLSWORTH L.AC. (LICENSED ACUPUNCTURIST/OWNER)
- **Authorized official phone:** (406) 531-0689

## Contact information

- **Practice address:** 200 E PINE ST, MISSOULA, MT 59802-4513
- **Practice address phone:** (406) 531-0689
- **Mailing address:** PO BOX 9153, MISSOULA, MT 59807-9153
- **Mailing address phone:** (406) 531-0689

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 171100000X | Acupuncturist | — | NULL | Yes |
| 171100000X | Acupuncturist | — | — | Yes |

## Other

- **Enumeration date:** 10/12/2020
- **Last updated:** 10/12/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 18802 | STATE MEDICAL ACUPUNCTURE LICENSE | MT |