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General NPI Number Information
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NPI Number | 1275490344
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Entity Type | Organization
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Legal Business Name | HEADWATERS BEHAVIORAL HEALTH, PLLC
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Dates
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Enumeration Date | 01/08/2026
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Last Update Date | 01/08/2026
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Provider Practice Location Address
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Address Line | 4 S DURANGO TRL
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City | THREE FORKS
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State | MT
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Zip | 59752-9600
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Country | US
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Telephone | 805-665-3460
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Fax |
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Provider Business Mailing Address
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Address Line | 2975 MAX AVE # 1042
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City | BOZEMAN
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State | MT
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Zip | 59718-7143
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Country | US
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Telephone | 805-665-3460
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Fax |
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Authorized Official
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Title or Position | THERAPIST AND MANAGER
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Name | MRS. COURTNEY SISCO
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Credential | LMFT
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Telephone | 805-813-2132
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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