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General NPI Number Information
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NPI Number | 1356910210
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Entity Type | Organization
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Legal Business Name | KINTSUGI COUNSELING PLLC
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Dates
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Enumeration Date | 06/23/2021
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Last Update Date | 06/23/2021
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Provider Practice Location Address
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Address Line | 1601 2ND AVE N STE 200A
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City | GREAT FALLS
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State | MT
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Zip | 59401-3243
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Country | US
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Telephone | 406-868-0228
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Fax | 877-828-5889
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Provider Business Mailing Address
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Address Line | 1601 2ND AVE N STE 200A
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City | GREAT FALLS
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State | MT
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Zip | 59401-3243
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Country | US
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Telephone | 406-868-0227
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Fax | 877-828-5889
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Authorized Official
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Title or Position | THERAPIST
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Name | MS. AMANDA MARIE WALKER
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Credential | LCPC
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Telephone | 406-868-0228
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282J00000X
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Taxonomy Name | Religious Nonmedical Health Care Institution
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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 | 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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