Individual
MS. LESLIE HAALAND DOMINICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, LCPC
Contact information
Practice address
2050 FAIRWAY DR STE 203, BOZEMAN, MT 59715-5810
(406) 478-6611
Mailing address
10619 KELLY CANYON RD, BOZEMAN, MT 59715-9688
(406) 478-6611
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
BBH-LCPC-LIC-50557
MT
101YP2500X
Professional Counselor
Primary
BBH-LCPC-LIC-50557
MT
Other
Enumeration date
12/29/2021
Last updated
12/29/2021
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