Individual
MS. PETRA GERARDA DE GROOT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCPC
Contact information
Practice address
210 N HIGGINS AVE, SUITE 327, MISSOULA, MT 59802-4462
(406) 728-7584
Mailing address
PO BOX 8388, MISSOULA, MT 59807-8388
(406) 728-7584
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
MT 441
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
74933
BLUE CROSS & BLUE SHIELD
MT
Enumeration date
05/08/2007
Last updated
07/08/2007
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