Healthcare Provider Details

I. General information

NPI: 1427676014
Provider Name (Legal Business Name): KIM BODILY PCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2020
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 CENTRAL AVE STE 225
GREAT FALLS MT
59401-3157
US

IV. Provider business mailing address

928 AVENUE D NW
GREAT FALLS MT
59404-1738
US

V. Phone/Fax

Practice location:
  • Phone: 406-209-8747
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberBBH-LCPC-LIC-50014
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: