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General NPI Number Information
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NPI Number | 1023525771
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Entity Type | Organization
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Legal Business Name | WILLOW CANYON COUNSELING SERVICES
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Dates
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Enumeration Date | 01/03/2018
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Last Update Date | 02/04/2022
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Provider Practice Location Address
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Address Line | 302 1ST ST W STE 203
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City | POLSON
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State | MT
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Zip | 59860-2602
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Country | US
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Telephone | 406-270-3447
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Fax |
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Provider Business Mailing Address
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Address Line | 42522 CANAL RD
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City | RONAN
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State | MT
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Zip | 59864-9002
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Country | US
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Telephone | 406-260-5085
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SHAUNDA MARIE ALBERT
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Credential | LCSW , LAC, MAC
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Telephone | 406-260-5085
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | BBH-SWLC-LIC-17314
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License Number State | MT
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number | BBH-LAC-LIC-1275
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License Number State | MT
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