NPIMap

Organization Active NPI

Eating Disorder Center of Montana

  • Mental Health Counselor
  • Bozeman, MT
National Provider Identifier
1053751487
Registry record updated Aug 28, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
EATING DISORDER CENTER OF MONTANA
Practice address
14 S Willson Ave
Suite 102
Bozeman, MT 59715-6232
Phone
(805) 637-4900
Fax
(406) 551-1209
NPI assigned
Jun 29, 2013
Last updated
Aug 28, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jeni Ruth Gochin, LMFT, LCPCNPI 1942494109
Title
Clinical Director
Phone
(805) 637-4900

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 9

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X Primary
Professional CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YP2500X
Clinical PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC0700X
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X
Registered DietitianGroup: 193200000X MULTI-SPECIALTY GROUP 133V00000X
General Practice Registered NurseGroup: 193200000X MULTI-SPECIALTY GROUP 163WG0000X
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X
Multi-Specialty Clinic/Center 261QM1300X

Addresses

Primary practice location

14 S Willson Ave
Suite 102
Bozeman, MT 59715-6232

Mailing address

14 S Willson Ave
Suite 102
Bozeman, MT 59715-6232
Phone (805) 637-4900

Other practice location 1

319 S Willson Ave
Bozeman, MT 59715-4632
Phone (406) 451-7370

National Provider Directory

National Provider Directory
Tax ID family
Eating Disorder Center of Montana3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

14 S Willson Ave
Ste 1
Bozeman, MT 59715

14 S Willson Ave
Ste 102
Bozeman, MT 59715
Phone (805) 637-4900

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1372464000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598572800000",
    "number": "1053751487",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14 S WILLSON AVE",
            "address_2": "SUITE 102",
            "city": "BOZEMAN",
            "state": "MT",
            "postal_code": "597156232",
            "telephone_number": "805-637-4900",
            "fax_number": "406-551-1209"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14 S WILLSON AVE",
            "address_2": "SUITE 102",
            "city": "BOZEMAN",
            "state": "MT",
            "postal_code": "597156232",
            "telephone_number": "805-637-4900",
            "fax_number": "406-551-1209"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "319 S Willson Ave",
            "address_purpose": "LOCATION",
            "city": "Bozeman",
            "state": "MT",
            "postal_code": "597154632",
            "country_code": "US",
            "telephone_number": "406-451-7370",
            "fax_number": "405-571-7956",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "EATING DISORDER CENTER OF MONTANA",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-06-29",
        "last_updated": "2020-08-28",
        "certification_date": "2020-08-28",
        "status": "A",
        "authorized_official_last_name": "GOCHIN",
        "authorized_official_first_name": "JENI",
        "authorized_official_middle_name": "RUTH",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "805-637-4900",
        "authorized_official_credential": "LMFT, LCPC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "163WG0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse, General Practice",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bozeman, MT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.