Basic Information
| Provider Information | |||||||||
| NPI: | 1801062096 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HALLIE BORNSTEIN BANZIGER PHD LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 935 HIGHLAND BLVD | ||||||||
| Address2: | SUITE 4400 | ||||||||
| City: | BOZEMAN | ||||||||
| State: | MT | ||||||||
| PostalCode: | 597156904 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4062193311 | ||||||||
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| Practice Location | |||||||||
| Address1: | 125 BANK ST | ||||||||
| Address2: | SUITE 310 | ||||||||
| City: | MISSOULA | ||||||||
| State: | MT | ||||||||
| PostalCode: | 598024407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4065497325 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/07/2008 | ||||||||
| LastUpdateDate: | 10/22/2008 | ||||||||
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| AuthorizedOfficialLastName: | BORNSTEIN BANZIGER | ||||||||
| AuthorizedOfficialFirstName: | HALLIE | ||||||||
| AuthorizedOfficialMiddleName: | ALYSSA | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4062193311 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PHD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 366 | MT | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 52501 | 01 | MT | BLUE CROSS | OTHER |