Healthcare Provider Details

I. General information

NPI: 1275305088
Provider Name (Legal Business Name): COURTNEY LYNN KOLIAS LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2023
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 2ND AVE N STE 528
GREAT FALLS MT
59401-3289
US

IV. Provider business mailing address

1601 2ND AVE N STE 528
GREAT FALLS MT
59401-3289
US

V. Phone/Fax

Practice location:
  • Phone: 406-799-6937
  • Fax:
Mailing address:
  • Phone: 406-799-6937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberBBH-LAC-LIC-88981
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: