Provider Demographics
NPI:1700559101
Name:SEGAR, RIVER GERARD (CBHPSS)
Entity type:Individual
Prefix:
First Name:RIVER
Middle Name:GERARD
Last Name:SEGAR
Suffix:
Gender:M
Credentials:CBHPSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6860 DONOVAN CREEK RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MT
Mailing Address - Zip Code:59825-9745
Mailing Address - Country:US
Mailing Address - Phone:406-529-2522
Mailing Address - Fax:
Practice Address - Street 1:202 BROOKS ST STE 300
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-4019
Practice Address - Country:US
Practice Address - Phone:406-926-1453
Practice Address - Fax:406-926-1454
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-30
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-BHPS-CRT-49018175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist