Provider Demographics
NPI:1720137714
Name:TRONTEL, EDWARD H (PHD)
Entity type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:H
Last Name:TRONTEL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 BURNS WAY
Mailing Address - Street 2:#4
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901
Mailing Address - Country:US
Mailing Address - Phone:406-752-5784
Mailing Address - Fax:406-752-0252
Practice Address - Street 1:1250 BURNS WAY
Practice Address - Street 2:#4
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901
Practice Address - Country:US
Practice Address - Phone:406-752-5784
Practice Address - Fax:406-752-0252
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT158103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0490025Medicaid
MT000005209Medicare ID - Type Unspecified
R09990Medicare UPIN