Provider Demographics
NPI:1316089451
Name:ROCKY MOUNTAIN NEUROPSYCHOLOGY PLLC
Entity type:Organization
Organization Name:ROCKY MOUNTAIN NEUROPSYCHOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:CORY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:406-582-4466
Mailing Address - Street 1:1648 ELLIS ST
Mailing Address - Street 2:#302
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-8810
Mailing Address - Country:US
Mailing Address - Phone:406-582-4466
Mailing Address - Fax:406-587-1513
Practice Address - Street 1:1648 ELLIS ST
Practice Address - Street 2:#302
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-8810
Practice Address - Country:US
Practice Address - Phone:406-582-4466
Practice Address - Fax:406-587-1513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT368103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0493221Medicaid
MT52571OtherBCBS MT