Provider Information for 1215209408
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ERICA JO TRIBBLE LCSW
Sex: Female
NPI: 1215209408
Last Updated: 2013-09-12
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1215209408 | ||||||||
| Enumeration Date | 2012-02-02 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | PO BOX 17531 MISSOULA, MT 59808-7531 United States Phone: 406-370-4294 | Fax: | ||||||||
| Primary Practice Address | 714 KENSINGTON AVE MISSOULA, MT 59801-5720 United States Phone: 406-370-4294 | Fax: | ||||||||
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