Healthcare Provider Details

I. General information

NPI: 1184528390
Provider Name (Legal Business Name): BEYOND RELEASE THERAPY AND REENTRY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2026
Last Update Date: 10/03/2026
Certification Date: 10/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3616 9TH AVE N
GREAT FALLS MT
59401-2227
US

IV. Provider business mailing address

3616 9TH AVE N
GREAT FALLS MT
59401-2227
US

V. Phone/Fax

Practice location:
  • Phone: 406-403-2157
  • Fax:
Mailing address:
  • Phone: 406-403-2157
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name: VICTORIA J JAGER
Title or Position: CLINICAL SERVICES DIRECTOR
Credential: LCPC, LAC
Phone: 406-350-3589