Healthcare Provider Details

I. General information

NPI: 1437774809
Provider Name (Legal Business Name): CONNECTED BRAIN & BODY BASED COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2020
Last Update Date: 03/31/2025
Certification Date: 03/31/2025
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

600 CENTRAL AVE STE 302
GREAT FALLS MT
59401-3141
US

V. Phone/Fax

Practice location:
  • Phone: 406-201-1485
  • Fax: 406-403-0312
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KIM BODILY
Title or Position: OWNER
Credential: MS, LCPC
Phone: 64-209-8747