Dakota Stump, BCBA
Individual provider Active NPI Behavior Analyst · Missoula, MT
NPI 1568056299 · NPPES record last updated Apr 9, 2024
Key facts
- NPI
- 1568056299
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Behavior Analyst 103K00000X
- License
- PSY-BA-LIC-5048 (MT)
- Practice address
- 3335 LT Moss Rd
Missoula, MT 59804-7222 - Phone
- (406) 549-6413
- Fax
- (406) 542-0143
- NPI assigned
- Feb 23, 2021
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY-BA-LIC-5048 | MT | MD | Behavioral Analyst |
| PSY-ABA-LIC-4512 | MT | MD | Assistant Behavior Analyst |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Assistant Behavior Analyst | 106E00000X | PSY-ABA-LIC-4512 | MT | |
| Behavior Analyst | 103K00000X | PSY-BA-LIC-5048 | MT | Yes |
Addresses
Primary practice location
3335 LT Moss Rd
Missoula, MT 59804-7222
Mailing address
3335 LT Moss Rd
Missoula, MT 59804-7222
Phone (406) 549-6413
Other providers in Missoula, MT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 9, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.