Healthcare Provider Details

I. General information

NPI: 1982073755
Provider Name (Legal Business Name): GLENDIVE COUNSELING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2015
Last Update Date: 09/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 W VALENTINE ST SUITE 2
GLENDIVE MT
59330-1666
US

IV. Provider business mailing address

115 W VALENTINE ST SUITE 2
GLENDIVE MT
59330-1666
US

V. Phone/Fax

Practice location:
  • Phone: 406-377-6217
  • Fax:
Mailing address:
  • Phone: 406-377-6217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWP-LCSW-LIC-4644
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberSWP-LCPC-LIC-2360
License Number StateMT

VII. Legacy identifiers

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

VIII. Authorized Official

Name: LINDA FARBER
Title or Position: OWNER
Credential: LCPC
Phone: 406-377-6217