Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 16845 | MT |
NPI | 1003270810 |
---|---|
Provider Name | Angela Otto |
First Address | Kalispell, MT 59901-3095 |
Second Address | Kalispell, MT 59901-3095 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2016 |
Last Update Date | 02/11/2021 |