Organization · NPI-2

Ally Psychiatric Wellness

Clinic/Center, Adult Mental Health · Bozeman, MT

NPI number1609524172
StatusActive
Last updated in NPPESOct 19, 2022

Details

NPI
1609524172
Entity type
Organization (NPI-2)
Legal business name
Ally Psychiatric Wellness
Organization subpart
No
Enumeration date
Mar 14, 2022
Certification date
Oct 19, 2022
Last updated
Oct 19, 2022

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
261QM0850X Clinic/Center, Adult Mental Health––Yes
363L00000X Nurse Practitioner––
363LF0000X Nurse Practitioner, Family––

Practice location

43 Mill Town Loop Ste C
Bozeman, MT 59718-6769

Phone 406-404-6711

Mailing address

3701 Trakker Trl
Suite 1b #35
Bozeman, MT 59718

Authorized official

Jentry De Castro
Nurse Practitioner
8168001308

Is something wrong?

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