Healthcare Provider Details

I. General information

NPI: 1669306726
Provider Name (Legal Business Name): MEGAN KOONTZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 3RD AVE E
KALISPELL MT
59901-4531
US

IV. Provider business mailing address

PO BOX 224
LAKESIDE MT
59922-0224
US

V. Phone/Fax

Practice location:
  • Phone: 406-219-8061
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberBBH-PCLC-LIC-89350
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: