Healthcare Provider Details

I. General information

NPI: 1265094601
Provider Name (Legal Business Name): BODHI TREE COUNSELING, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2019
Last Update Date: 04/16/2020
Certification Date: 04/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

527 LAKE ELMO DR
BILLINGS MT
59105-3051
US

IV. Provider business mailing address

540 JEMSTONE DR
BILLINGS MT
59101-6854
US

V. Phone/Fax

Practice location:
  • Phone: 406-694-5000
  • Fax: 406-245-1156
Mailing address:
  • Phone: 406-694-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: NATHAN LEE CHURCH
Title or Position: MENTAL HEALTH THERAPIST
Credential: LCSW, LAC
Phone: 406-694-5000