Healthcare Provider Details

I. General information

NPI: 1962217166
Provider Name (Legal Business Name): 1111 NEW BEGINNINGS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2025
Last Update Date: 07/30/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2139 BROADWATER AVE STE F
BILLINGS MT
59102-4761
US

IV. Provider business mailing address

PO BOX 23704
BILLINGS MT
59104-3704
US

V. Phone/Fax

Practice location:
  • Phone: 406-208-5264
  • Fax: 406-208-5264
Mailing address:
  • Phone: 406-208-5264
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: KENDY MCCOY
Title or Position: OWNER
Credential: LCPC, LAC
Phone: 406-208-5264