Provider Demographics
NPI:1801782164
Name:MISSOULA BEHAVIORAL CONSULTING, PLLC
Entity type:Organization
Organization Name:MISSOULA BEHAVIORAL CONSULTING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD CERTIFIED BEHAVIOR ANALYST
Authorized Official - Prefix:
Authorized Official - First Name:JOLYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAKELEY
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA, LBA
Authorized Official - Phone:406-491-7450
Mailing Address - Street 1:2115 TRAIL ST
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-1537
Mailing Address - Country:US
Mailing Address - Phone:406-491-7450
Mailing Address - Fax:
Practice Address - Street 1:2115 TRAIL ST
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-1537
Practice Address - Country:US
Practice Address - Phone:406-491-7450
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-14
Last Update Date:2025-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services