Healthcare Provider Details

I. General information

NPI: 1003694548
Provider Name (Legal Business Name): MINDFUL HEALING THERAPY AND RECOVERY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2023
Last Update Date: 11/02/2023
Certification Date: 11/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1174 STONERIDGE DR STE 304
BOZEMAN MT
59718-9850
US

IV. Provider business mailing address

483 TALON WAY
BOZEMAN MT
59718-9816
US

V. Phone/Fax

Practice location:
  • Phone: 406-414-7055
  • Fax:
Mailing address:
  • Phone: 406-414-7055
  • 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 Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: ROBYN CARR
Title or Position: OWNER
Credential: LCPC, LAC, LMFT
Phone: 406-414-7055