Individual
GLEN HOWARD STARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
20 CORNERSTONE WAY, BOZEMAN, MT 59718-6004
(406) 209-8763
Mailing address
361 PEACE PIPE DR, BOZEMAN, MT 59715-1769
(406) 579-4255
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
BBH-LCPC-LIC-79275
MT
101YP2500X
Professional Counselor
Primary
BBH-LCPC-LIC-79275
MT
Other
Enumeration date
10/23/2023
Last updated
06/23/2025
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