Ambrosia Isely, LCSW, ACLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

BBH-LCSW-LIC-62233 Issued in MT

Practice address

725 W Alder St Ste 22
Missoula, MT 59802-4026

Phone

(406) 750-6899

NPI assigned

Jan 17, 2023

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Safe Space Therapy LLC

  • Clinical Social Worker
  • Bucky, WV
  • NPI 1588379044
  NPD Authorized official

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

{
    "created_epoch": "1673913600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1673913600000",
    "number": "1891400537",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "725 W ALDER ST STE 22",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598024026",
            "telephone_number": "406-750-6899"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "725 W ALDER ST STE 22",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598024026",
            "telephone_number": "406-750-6899"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ISELY",
        "first_name": "AMBROSIA",
        "credential": "LCSW, ACLC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-01-17",
        "last_updated": "2023-01-17",
        "certification_date": "2023-01-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MT",
            "license": "BBH-LCSW-LIC-62233",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ambrosia@safespacetherapy.app",
            "affiliation": "N",
            "endpointDescription": "business email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "725 W Alder St Ste 22",
            "city": "Missoula",
            "state": "MT",
            "country_code": "US",
            "postal_code": "598024026",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Intermountain Planned Parenthood
• Angela Marie Ireland, PA-C
• Ivy Vanessa Irvine, L.C.S.W.
• Katherine Isaacson, LCPC
• Stephanie Ammons Isbell, COUNSELOR
• Taylor Isom
• Tara Ivanovitch, LCSW, LAC
• Sage Iverson
• Calia Ivy
• J Miller Physical Therapy LLC

• Clinical Social Worker in Missoula, MT
• Providers in Missoula, MT by specialty
• Clinical Social Worker in Montana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2023; 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.