Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | ||
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | BBH-ACLC-LIC-14219 | MT |
N | 101YP1600X | Pastoral Counselor | ||
N | 102L00000X | Psychologist | ||
N | 103T00000X | Psychologist |
NPI | 1124531785 |
---|---|
Provider Name | Mr. James Marion Del Duca III |
First Address | Bozeman, MT 59715-1780 |
Second Address | Bozeman, MT 59715-1780 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/11/2017 |
Last Update Date | 06/11/2017 |