Organization
WHOLLY AUTHENTIC LIFE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TAMMIE S SMITH LCPC (MBR)
(406) 799-2711
Entity
Organization
Contact information
Practice address
201 1ST AVE N, FAIRFIELD, MT 59436-9245
(406) 799-2711
(406) 467-3407
Mailing address
PO BOX 907, FAIRFIELD, MT 59436-0907
(406) 799-2711
(406) 467-3407
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
08/31/2022
Last updated
09/29/2023
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