Healthcare Provider Details

I. General information

NPI: 1114516135
Provider Name (Legal Business Name): LITTLE SUNFLOWER COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2021
Last Update Date: 12/15/2023
Certification Date: 12/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 SW HIGGINS AVE STE 107
MISSOULA MT
59803-1489
US

IV. Provider business mailing address

2120 S RESERVE ST # 1020
MISSOULA MT
59801-6451
US

V. Phone/Fax

Practice location:
  • Phone: 406-214-3810
  • Fax:
Mailing address:
  • Phone: 406-214-3810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MARIE PETTIT
Title or Position: OWNER
Credential: LCPC
Phone: 406-531-3948