Organization
ALCOHOL & DRUG SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHELLY A. JOHNSON (DIRECTOR)
(406) 856-5493
Entity
Organization
Contact information
Practice address
2310 N 7TH AVE, BOZEMAN, MT 59715-2550
(406) 586-5493
(406) 587-1238
Mailing address
2310 N 7TH AVE, BOZEMAN, MT 59715-2550
(406) 586-5493
(406) 587-1238
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
201-13
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
77039
—
MT
Enumeration date
11/15/2012
Last updated
11/15/2012
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