=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194039370
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FRESH STEPS EAP, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/30/2010
-----------------------------------------------------
Last Update Date | 07/30/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6515 GREEN MEADOW DR
-----------------------------------------------------
City | HELENA
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59602-8115
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-558-4743
-----------------------------------------------------
Fax | 406-204-4518
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6515 GREEN MEADOW DR
-----------------------------------------------------
City | HELENA
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59602-8115
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-558-4743
-----------------------------------------------------
Fax | 406-204-4518
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. DARCIE KELLY
-----------------------------------------------------
Credential | MSW
-----------------------------------------------------
Telephone | 406-558-4743
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 1444
-----------------------------------------------------
License Number State | MT
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 907
-----------------------------------------------------
License Number State | MT
-----------------------------------------------------