Healthcare Provider Details

I. General information

NPI: 1275490344
Provider Name (Legal Business Name): HEADWATERS BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

607 S MAIN ST UNIT 2
THREE FORKS MT
59752-8956
US

IV. Provider business mailing address

PO BOX 251
THREE FORKS MT
59752-0251
US

V. Phone/Fax

Practice location:
  • Phone: 406-630-5542
  • Fax:
Mailing address:
  • Phone: 406-630-5542
  • Fax: 406-215-1931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: MRS. COURTNEY SISCO
Title or Position: THERAPIST AND MANAGER
Credential: LMFT
Phone: 805-813-2132