Basic Information
| Provider Information | |||||||||
| NPI: | 1760026090 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BANDY | ||||||||
| FirstName: | NICOLE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1732 S 72ND ST W | ||||||||
| Address2: | |||||||||
| City: | BILLINGS | ||||||||
| State: | MT | ||||||||
| PostalCode: | 591063538 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4066513131 | ||||||||
| FaxNumber: | 4062567026 | ||||||||
| Practice Location | |||||||||
| Address1: | 1441 GOVERNORS BLVD | ||||||||
| Address2: | |||||||||
| City: | BILLINGS | ||||||||
| State: | MT | ||||||||
| PostalCode: | 591051505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4062815812 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/30/2019 | ||||||||
| LastUpdateDate: | 10/30/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | BBH-PCLC-LIC-30857 | MT | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.