EATING DISORDER CENTER OF MONTANA (NPI# 1053751487) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1053751487 |
| Entity Type | Organization |
| Organization Name | EATING DISORDER CENTER OF MONTANA |
| Practice Address |
14 S Willson Ave Suite 102 Bozeman MT 59715-6232 |
| Practice Telephone | 8056374900 |
| Practice Fax Number | 4065511209 |
| Mailing Telephone | 8056374900 |
| Mailing Fax Number | 4065511209 |
| Enumeration Date | 2013-06-29 |
| Last Update Date | 2020-08-28 |
| Authorized Official Name | JENI RUTH GOCHIN (CLINICAL DIRECTOR) |
| Authorized Official Telephone | 8056374900 |
| Authorized Official Credential | LMFT, LCPC |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QM0801X |
Clinic/Center Specialization: Mental Health (Including Community Mental Health Center) |
Ambulatory Health Care Facilities | ||
| N | 261QM1300X |
Clinic/Center Specialization: Multi-Specialty |
Ambulatory Health Care Facilities | ||
| N | 103TC0700X |
Psychologist Specialization: Clinical |
Behavioral Health & Social Service Providers | ||
| N | 1041C0700X |
Social Worker Specialization: Clinical |
Behavioral Health & Social Service Providers | ||
| N | 133V00000X | Dietitian, Registered | Dietary & Nutritional Service Providers | ||
| N | 163WG0000X |
Registered Nurse Specialization: General Practice |
Nursing Service Providers | ||
| N | 2084P0800X |
Psychiatry & Neurology Specialization: Psychiatry |
Allopathic & Osteopathic Physicians | ||
| Y | 101YM0800X |
Counselor Specialization: Mental Health |
Behavioral Health & Social Service Providers | ||
| N | 101YP2500X |
Counselor Specialization: Professional |
Behavioral Health & Social Service Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 319 S Willson Ave, Bozeman, MT 597154632 | 4064517370 | 4055717956 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922606920 | Eating Disorder Center of Montana | Counselor | 319 S Willson Ave, Bozeman, MT 59715-4632 | 2020-10-12 |
| Street Address |
14 S WILLSON AVE SUITE 102 |
| City | BOZEMAN |
| State | MT |
| Zip Code | 59715-6232 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942494109 | Jeni Ruth Gochin | Counselor | 14 S Willson Ave, Bozeman, MT 59715-6232 | 2007-08-30 |
| 1487206868 | Rebecca Jones | Dietitian, Registered | 14 S Willson Ave, Bozeman, MT 59715-6232 | 2019-07-15 |
| 1184286262 | Carrie E Welch | Counselor | 14 S Willson Ave, Bozeman, MT 59715-6232 | 2019-06-28 |
| 1447815345 | Warren Vaughan | Counselor | 14 S Willson Ave, Bozeman, MT 59715-6232 | 2019-05-06 |
| 1871062208 | Lindsey Grauman | Dietitian, Registered | 14 S Willson Ave, Bozeman, MT 59715-6232 | 2018-11-14 |
| 1144798760 | Alexandra Fox | Dietitian, Registered | 14 S Willson Ave, Bozeman, MT 59715-6232 | 2018-11-13 |
| 1942738737 | Rachel Patrick | Dietitian, Registered | 14 S Willson Ave, Bozeman, MT 59715-6232 | 2017-05-24 |
| 1184019200 | Bridget Ashcraft | Counselor | 14 S Willson Ave, Bozeman, MT 59715-6232 | 2015-04-06 |
| 1558794164 | Meghan Womack | Dietitian, Registered | 14 S Willson Ave, Bozeman, MT 59715-6232 | 2013-08-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477152288 | Ch Mh Services (il), LLC | Clinic/Center | 233 E Main St Suite 401, Bozeman, MT 59715 | 2020-10-22 |
| 1134735269 | Montana Therapy and Consulting Pllc | Social Worker | 110 S Grand Ave, Floor 2, Bozeman, MT 59715 | 2020-09-23 |
| 1831715994 | Alyson Raph | Student in an Organized Health Care Education/Training Program | 1 Anna Pearl Sherrick Hal, Bozeman, MT 59715 | 2020-06-24 |
| 1639702780 | Miranda Shields | Massage Therapist | 1001 W. Oak St. Bldg C Ste 210, Bozeman, MT 59715 | 2020-02-18 |
| 1154988590 | Christina Yancy | Massage Therapist | Bldg C, Ste 210, 1001 W Oak St, Bozeman, MT 59715 | 2019-05-21 |
| 1962068767 | Julie A Hisey | Physical Therapist | 1700 W. Koch, Suite 12, Bozeman, MT 59715 | 2019-05-16 |
| 1639631633 | Joshua Wallace | Massage Therapist | 1001 W Oak St, Bldg. C Ste. 210, Bozeman, MT 59715 | 2019-04-01 |
| 1528523388 | Judith Margaret Firehammer | Psychologist | 37 East Main St, Suite 7, Bozeman, MT 59715 | 2019-02-06 |
| 1194280875 | Erica Kotick | Counselor | 2246 Boot Hill Court, Suite 4, Bozeman, MT 59715 | 2019-02-06 |
| 1194291609 | Providence Mental Health Pllc | Social Worker | 2246 Boot Hill Ct. Unit #4, Bozeman, MT 59715 | 2018-10-23 |
| Find all providers in zip 59715 | ||||
| Taxonomy Code | 101YM0800X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073112520 | Autumn R Clowes | Counselor | 20 Arrowhead Trl, Bozeman, MT 59718-9452 | 2020-10-25 |
| 1043824683 | Jacqueline Bence | Counselor | 2246 Boot Hill Ct # 3, Bozeman, MT 59715-7248 | 2020-09-01 |
| 1851902423 | Danielle Josephine Stack | Counselor | 2115 Durston Rd Ste 10, Bozeman, MT 59718-2800 | 2020-08-16 |
| 1700496338 | Emily M Tage | Counselor | 2417 W Main St Ste 2, Bozeman, MT 59718-3811 | 2020-08-07 |
| 1629686811 | Terese E Jeppson | Counselor | 1103 S Willson Ave, Bozeman, MT 59715-5248 | 2020-07-14 |
| 1700413366 | Brooke Sibary | Counselor | 1609 W Babcock St Ste A, Bozeman, MT 59715-4018 | 2020-03-24 |
| 1922658889 | Amanda Lynn Kuehn Forney | Counselor | 601 Nikles Dr Ste 12, Bozeman, MT 59715-2570 | 2019-09-12 |
| 1538728043 | Joanna Wright | Counselor | 1195 Stoneridge Dr # 4a-b, Bozeman, MT 59718-7048 | 2019-06-08 |
| 1194280875 | Erica Kotick | Counselor | 2246 Boot Hill Court, Suite 4, Bozeman, MT 59715 | 2019-02-06 |
| 1528574423 | Michael Wayne Hetherington | Counselor | 4255 Kimberwicke St, Bozeman, MT 59718-5700 | 2017-12-14 |
| Find all providers in BOZEMAN | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.