Ian Anderson
Individual provider Active NPI Professional Counselor · Bozeman, MT
NPI 1962053314 · NPPES record last updated Apr 25, 2023
Key facts
- NPI
- 1962053314
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- BBH-LCPC-LIC-55424 (MT)
- Practice address
- 1807 W Dickerson St Ste D
Bozeman, MT 59715-1311 - Phone
- (406) 219-8321
- Fax
- (406) 215-4554
- NPI assigned
- Sep 26, 2019
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Nov 1, 2025 through Nov 1, 2027
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| BBH-PCLC-LIC-38594 | MT | MD | Mental Health Counselor |
| BBH-LCPC-LIC-55424 | MT | MD | Professional Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor |
101YM0800X | BBH-PCLC-LIC-38594 | MT | |
| Professional Counselor | 101YP2500X | BBH-LCPC-LIC-55424 | MT | Yes |
Addresses
Primary practice location
1807 W Dickerson St Ste D
Bozeman, MT 59715-1311
Mailing address
601 S Grand Ave
Bozeman, MT 59715-5219
Phone (406) 580-5071
Other providers in Bozeman, MT
- Amy Dawn Anderson
- Andrea Esther Anderson
- Candace J Anderson
- Hannah Marie Anderson
- Holly Lynn Anderson
- Jason Thomas Anderson
- Jenenne Howell Anderson
- Jessica Lynn Anderson
- John Anderson
- Justin Lee Anderson
All providers in Bozeman, MT · Professional Counselor in Montana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 25, 2023. 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.
- Opt Out Affidavits (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.