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EATING DISORDER CENTER OF MONTANA

Behavioral Health & Social Service Providers Counselor Mental Health

Provider NPI: 1053751487

Organization Information:
Organization Name:  EATING DISORDER CENTER OF MONTANA
Organization is not Subpart
Authorized Official:  JENI RUTH GOCHIN  OWNER  805-637-4900

Practice Location:
14 S WILLSON AVE SUITE 102 BOZEMAN, MT 59715-6232 US
Tel: 805-637-4900  Fax: 406-551-1209

Business Mailing Address:
14 S WILLSON AVE SUITE 102 BOZEMAN, MT 59715-6232 US
Tel: 805-637-4900  Fax: 406-551-1209

NPI Information:
NPI: 1053751487
Entity Type: Organization

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
N101YM0800XBehavioral Health & Social Service Providers
Counselor
Mental Health
N103TC0700XBehavioral Health & Social Service Providers
Psychologist
N1041C0700XBehavioral Health & Social Service Providers
Social Worker
N133V00000XDietary & Nutritional Service Providers
Dietitian, Registered
N163WG0000XNursing Service Providers
Registered Nurse
N2084P0800XPhysicians
Psychiatry & Neurology
N261QM1300XAmbulatory Health Care Facilities
Clinic/Center
Y261QM0801XAmbulatory Health Care Facilities
Clinic/Center

Other Provider Identifiers:

IssuerNumberStateType



American Medical Association 2012 taxonomy code information

Code: 261QM0801X

Type:

Classification:



Definition:



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