| Rocky Mountain Psychotherapy & Neurofeedback | |
|
2601 S 3rd St W Missoula MT 59804-1143 | |
| (406) 396-3500 | |
| Not Available |
| Full Name | Rocky Mountain Psychotherapy & Neurofeedback |
|---|---|
| Speciality | Social Worker |
| Location | 2601 S 3rd St W, Missoula, Montana |
| Authorized Official Name and Position | Dorothy Rogers (OWNER) |
| Authorized Official Contact | 4063963500 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Rocky Mountain Psychotherapy & Neurofeedback 2601 S 3rd St W Missoula MT 59804-1143 Ph: () - | Rocky Mountain Psychotherapy & Neurofeedback 2601 S 3rd St W Missoula MT 59804-1143 Ph: (406) 396-3500 |
| NPI Number | 1417493883 |
|---|---|
| Provider Enumeration Date | 01/10/2017 |
| Last Update Date | 01/10/2017 |
| Medicare PECOS PAC ID | 3173806627 |
|---|---|
| Medicare Enrollment ID | O20170208001584 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417493883 | NPI | - | NPPES |
| 12167320 | Other | MT | CAQH |
| 0000071125 | Other | MT | BLUE CROSS BLUE SHIELD |
| 3323973 | Other | MT | PACIFIC SOURCE |
| 0503711 | Medicaid | MT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | BBH-LCSW-LIC-656 (Montana) | Primary |
| 1041C0700X | Social Worker - Clinical | BBH-LCSW-LIC-20257 (Montana) | Secondary |
| Provider Name | Dorothy E Rogers |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1134168818 PECOS PAC ID: 7214940097 Enrollment ID: I20060720000413 |
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