Individual
CHASE GANNON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
202 BROOKS ST STE 300, MISSOULA, MT 59801-4019
(406) 926-1453
Mailing address
519 FLOOD RD, GREAT FALLS, MT 59404-6442
(406) 868-7502
Taxonomy
Speciality
Code
Description
License number
State
103TA0400X
Addiction (Substance Use Disorder) Psychologist
Primary
BBH-LAC-LIC-79686
MT
Other
Enumeration date
05/16/2025
Last updated
05/16/2025
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