Healthcare Provider Details

I. General information

NPI: 1699602532
Provider Name (Legal Business Name): KOINONIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 1ST AVE
ST IGNATIUS MT
59865-7748
US

IV. Provider business mailing address

PO BOX 1016
ST IGNATIUS MT
59865-1016
US

V. Phone/Fax

Practice location:
  • Phone: 406-641-7230
  • Fax: 406-641-7231
Mailing address:
  • Phone: 406-641-7230
  • Fax: 406-641-7231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: JULIE FLECK
Title or Position: ADMINISTRATOR
Credential: L.C.S.W.
Phone: 406-270-8748