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1601 2nd Ave N Suite 200 D Great Falls MT 59401-3259 | |
| (406) 836-2714 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Counselor - Addiction (substance Use Disorder) |
| Location | 1601 2nd Ave N, Great Falls, Montana |
| Authorized Official Name and Position | Cheryl Ann Basta (LICENSED ADDICTION COUNSELOR) |
| Authorized Official Contact | 4068362714 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1601 2nd Ave N Suite 200 D Great Falls MT 59401-3259 Ph: (406) 836-2714 | 1601 2nd Ave N Suite 200 D Great Falls MT 59401-3259 Ph: (406) 836-2714 |
| NPI Number | 1972975696 |
|---|---|
| Provider Enumeration Date | 10/21/2015 |
| Last Update Date | 10/21/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972975696 | NPI | - | NPPES |
| 1290 | Other | MT | STATE LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | 1290 (Montana) | Primary |
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