Healthcare Provider Details

I. General information

NPI: 1558491399
Provider Name (Legal Business Name): FULL CIRCLE COUNSELING SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 06/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CONSUMER DIRECT WAY
MISSOULA MT
59808-5037
US

IV. Provider business mailing address

100 CONSUMER DIRECT WAY
MISSOULA MT
59808-5037
US

V. Phone/Fax

Practice location:
  • Phone: 866-438-8591
  • Fax: 406-532-1922
Mailing address:
  • Phone: 866-438-8591
  • Fax: 406-532-1922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number11085
License Number StateMT

VIII. Authorized Official

Name: KATIE TROTTER
Title or Position: CHIEF ADMINISTRATIVE OFFICER
Credential:
Phone: 406-532-1931