Ouroboros Mental Health PLLC
Organization Active NPI Clinic/Center · Bozeman, MT
NPI 1396561387 · NPPES record last updated Nov 25, 2024
Key facts
- NPI
- 1396561387
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Clinic/Center 261Q00000X
- Legal business name
- OUROBOROS MENTAL HEALTH PLLC
- Practice address
- 20 Cornerstone Way
Bozeman, MT 59718-6004 - Phone
- (406) 581-5146
- NPI assigned
- Nov 25, 2024
- Organization subpart
- No
Authorized official
- Name
- Fraser Ball, PMHNP-BC
- Title
- Owner
- Phone
- (406) 581-5146
Practitioners 1
-
Fraser Ball, PMHNP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MT
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20251021002166 | MT | Part B Supplier - Clinic/Group Practice | 8729576970 |
Receives reassigned benefits from 1 practitioner Practice locations: Bozeman, MT |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinic/Center | 261Q00000X | Yes |
Addresses
Primary practice location
20 Cornerstone Way
Bozeman, MT 59718-6004
Mailing address
20 Cornerstone Way
Bozeman, MT 59718-6004
Phone (406) 581-5146
Other providers in Bozeman, MT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 25, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.