Organization
ROCKY MOUNTAIN PSYCHOTHERAPY & NEUROFEEDBACK
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DOROTHY ROGERS (OWNER)
(406) 396-3500
Entity
Organization
Contact information
Practice address
2601 S 3RD ST W, MISSOULA, MT 59804-1143
(406) 396-3500
Mailing address
2601 S 3RD ST W, MISSOULA, MT 59804-1143
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
BBH-LCSW-LIC-20257
MT
1041C0700X
Clinical Social Worker
Primary
BBH-LCSW-LIC-656
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000071125
BLUE CROSS BLUE SHIELD
MT
05
—
0503711
—
MT
01
—
12167320
CAQH
MT
01
—
3323973
PACIFIC SOURCE
MT
Enumeration date
01/10/2017
Last updated
01/10/2017
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