| 121 Psychotherapy Pllc | |
|
121 Hickory St Suite 1 Missoula MT 59801-1896 | |
| (406) 830-3069 | |
| (406) 830-3069 |
| Full Name | 121 Psychotherapy Pllc |
|---|---|
| Speciality | Psychologist |
| Location | 121 Hickory St, Missoula, Montana |
| Authorized Official Name and Position | Alison Cobb (OWNER) |
| Authorized Official Contact | 4068303069 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| 121 Psychotherapy Pllc 121 Hickory St Suite 1 Missoula MT 59801-1896 Ph: (406) 830-3069 | 121 Psychotherapy Pllc 121 Hickory St Suite 1 Missoula MT 59801-1896 Ph: (406) 830-3069 |
| NPI Number | 1770874463 |
|---|---|
| Provider Enumeration Date | 04/28/2011 |
| Last Update Date | 06/03/2011 |
| Medicare PECOS PAC ID | 4587841812 |
|---|---|
| Medicare Enrollment ID | O20110614000113 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770874463 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| Provider Name | Alison M Cobb |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1538313762 PECOS PAC ID: 1456412022 Enrollment ID: I20081202000395 |
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