Organization
ALLY PSYCHIATRIC WELLNESS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JENTRY DE CASTRO DNP, FNP-C (NURSE PRACTITIONER)
(816) 800-1308
Entity
Organization
Contact information
Practice address
43 MILL TOWN LOOP STE C, BOZEMAN, MT 59718-6769
(406) 404-6711
Mailing address
3701 TRAKKER TRL, SUITE 1B #35, BOZEMAN, MT 59718
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
363L00000X
Nurse Practitioner
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1164920088
—
MT
Enumeration date
03/14/2022
Last updated
10/19/2022
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