Healthcare Provider Details

I. General information

NPI: 1558122564
Provider Name (Legal Business Name): MIND OVER MATTER COACHING & COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2024
Last Update Date: 01/17/2024
Certification Date: 01/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 CRESTVIEW DR UNIT 104
BIGFORK MT
59911-3559
US

IV. Provider business mailing address

439 GRAND DR # 142
BIGFORK MT
59911-3614
US

V. Phone/Fax

Practice location:
  • Phone: 406-393-8083
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: HEIDI HOUSER
Title or Position: BOOKKEEPER
Credential:
Phone: 406-249-4292