Organization
SOUTHWEST CHEMICAL DEPENDENCY PROGRAM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SANDRA B COOK LAC (LICENSED ADDICTION COUNSELOR)
(406) 683-4305
Entity
Organization
Contact information
Practice address
730 N MONTANA ST, SUITE 9, DILLON, MT 59725-8497
(406) 683-4305
(406) 683-9767
Mailing address
730 N MONTANA ST, P.O. BOX 527, DILLON, MT 59725-8497
(406) 683-4305
(406) 683-9767
Taxonomy
Speciality
Code
Description
License number
State
251300000X
Local Education Agency (LEA)
Primary
261QR0404X
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0320076
—
MT
Enumeration date
03/20/2007
Last updated
08/22/2020
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