Individual
GLENN JACOB FAIRHURST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
33 DIVISION RD UNIT 1, GREAT FALLS, MT 59404-1410
(406) 781-2074
Mailing address
33 DIVISION RD UNIT 1, GREAT FALLS, MT 59404-1410
(406) 781-2074
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
BBHPCLCLIC70082
MT
Other
Enumeration date
01/30/2024
Last updated
01/30/2024
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