Provider Demographics
NPI: | 1588966584 |
---|---|
Name: | BIG SKY THERAPEUTIC SERVICES, PLLC |
Entity type: | Organization |
Organization Name: | BIG SKY THERAPEUTIC SERVICES, PLLC |
Other - Org Name: | <UNAVAIL> |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | BRETT |
Authorized Official - Middle Name: | EDWARD |
Authorized Official - Last Name: | GILLEO |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | LCPC, LMFT, BCBA |
Authorized Official - Phone: | 406-240-2045 |
Mailing Address - Street 1: | PO BOX 6451 |
Mailing Address - Street 2: | |
Mailing Address - City: | GREAT FALLS |
Mailing Address - State: | MT |
Mailing Address - Zip Code: | 59406-6451 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 406-240-2045 |
Mailing Address - Fax: | 406-545-2276 |
Practice Address - Street 1: | 1601 2ND AVE N STE 700 |
Practice Address - Street 2: | |
Practice Address - City: | GREAT FALLS |
Practice Address - State: | MT |
Practice Address - Zip Code: | 59401-3288 |
Practice Address - Country: | US |
Practice Address - Phone: | 406-205-0452 |
Practice Address - Fax: | 406-545-2276 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2010-11-23 |
Last Update Date: | 2023-02-25 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
101Y00000X, 101YM0800X, 101YP2500X, 103K00000X, 103TB0200X, 103TC2200X, 104100000X, 106H00000X, 106S00000X, 251C00000X, 251K00000X, 252Y00000X, 253J00000X, 251S00000X | ||
MT | LCPC 1009 | 251B00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 251S00000X | Agencies | Community/Behavioral Health | ||
No | 101Y00000X | Behavioral Health & Social Service Providers | Counselor | Group - Multi-Specialty | |
No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Multi-Specialty |
No | 101YP2500X | Behavioral Health & Social Service Providers | Counselor | Professional | Group - Multi-Specialty |
No | 103K00000X | Behavioral Health & Social Service Providers | Behavior Analyst | Group - Multi-Specialty | |
No | 103TB0200X | Behavioral Health & Social Service Providers | Psychologist | Cognitive & Behavioral | Group - Multi-Specialty |
No | 103TC2200X | Behavioral Health & Social Service Providers | Psychologist | Clinical Child & Adolescent | Group - Multi-Specialty |
No | 104100000X | Behavioral Health & Social Service Providers | Social Worker | Group - Multi-Specialty | |
No | 106H00000X | Behavioral Health & Social Service Providers | Marriage & Family Therapist | Group - Multi-Specialty | |
No | 106S00000X | Behavioral Health & Social Service Providers | Behavior Technician | Group - Multi-Specialty | |
No | 251B00000X | Agencies | Case Management | ||
No | 251C00000X | Agencies | Day Training, Developmentally Disabled Services | Group - Multi-Specialty | |
No | 251K00000X | Agencies | Public Health or Welfare | Group - Multi-Specialty | |
No | 252Y00000X | Agencies | Early Intervention Provider Agency | Group - Multi-Specialty | |
No | 253J00000X | Agencies | Foster Care Agency | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
MT | 1588966584 | Medicaid |