Healthcare Provider Details

I. General information

NPI: 1891317608
Provider Name (Legal Business Name): OPEN HEARTS COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2020
Last Update Date: 02/10/2021
Certification Date: 02/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2023 STADIUM DR STE 1C
BOZEMAN MT
59715-0613
US

IV. Provider business mailing address

1627 W MAIN ST # 238
BOZEMAN MT
59715-4011
US

V. Phone/Fax

Practice location:
  • Phone: 406-219-8359
  • Fax:
Mailing address:
  • Phone: 360-556-7188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: CAROLINE WHISMAN-BLAIR
Title or Position: OWNER AND PROVIDER
Credential: LCSW
Phone: 360-556-7188