Healthcare Provider Details

I. General information

NPI: 1568017275
Provider Name (Legal Business Name): PALISADES COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2019
Last Update Date: 08/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 W 22ND ST
RED LODGE MT
59068
US

IV. Provider business mailing address

PO BOX 1802
RED LODGE MT
59068-1802
US

V. Phone/Fax

Practice location:
  • Phone: 406-446-9817
  • Fax:
Mailing address:
  • Phone: 406-446-9817
  • 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 Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: JOHN MONROE
Title or Position: MENTAL HEALTH THERAPIST
Credential: LCPC, LMFT
Phone: 406-446-9817