Healthcare Provider Details

I. General information

NPI: 1093650731
Provider Name (Legal Business Name): KAYLA M RACINE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1219 CENTRAL AVE
GREAT FALLS MT
59401-3777
US

IV. Provider business mailing address

2612 1ST AVE N
GREAT FALLS MT
59401-3326
US

V. Phone/Fax

Practice location:
  • Phone: 406-866-0350
  • Fax:
Mailing address:
  • Phone: 406-403-2576
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberBBH-LAC-LIC-88225
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: