Provider Demographics
NPI:1538592894
Name:MONTANA STATE UNIVERSITY COUNSELING & PSYCHOLOGICAL SERVICES
Entity type:Organization
Organization Name:MONTANA STATE UNIVERSITY COUNSELING & PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST, DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:DONAHOE
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:406-994-4531
Mailing Address - Street 1:PO BOX 173180
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59717-3180
Mailing Address - Country:US
Mailing Address - Phone:406-994-4531
Mailing Address - Fax:406-994-2485
Practice Address - Street 1:211 SWINGLE
Practice Address - Street 2:MONTANA STATE UNIVERSITY - BOZEMAN
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59717-3180
Practice Address - Country:US
Practice Address - Phone:406-994-4531
Practice Address - Fax:406-994-2485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-09
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health