Healthcare Provider Details

I. General information

NPI: 1356910210
Provider Name (Legal Business Name): KINTSUGI COUNSELING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2021
Last Update Date: 06/23/2021
Certification Date: 06/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 2ND AVE N STE 200A
GREAT FALLS MT
59401-3243
US

IV. Provider business mailing address

1601 2ND AVE N STE 200A
GREAT FALLS MT
59401-3243
US

V. Phone/Fax

Practice location:
  • Phone: 406-868-0228
  • Fax: 877-828-5889
Mailing address:
  • Phone: 406-868-0227
  • Fax: 877-828-5889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code282J00000X
TaxonomyReligious Nonmedical Health Care Institution
License Number
License Number State

VIII. Authorized Official

Name: MS. AMANDA MARIE WALKER
Title or Position: THERAPIST
Credential: LCPC
Phone: 406-868-0228