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General NPI Number Information
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NPI Number | 1396202461
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Entity Type | Organization
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Legal Business Name | GLACIER COUNSELING AND ANIMAL ASSISTED THERAPY
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Dates
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Enumeration Date | 02/26/2019
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Last Update Date | 02/26/2019
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Provider Practice Location Address
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Address Line | 127 W. MAIN STREET SIGNAL SQUARE SUIT A
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City | HAMILTON
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State | MT
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Zip | 59840
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Country | US
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Telephone | 509-630-3107
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Fax |
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Provider Business Mailing Address
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Address Line | 2035 POPPY LN
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City | CORVALLIS
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State | MT
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Zip | 59828-9629
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Country | US
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Telephone | 509-630-3107
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KIMBER LEE SMITH
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Credential | LCPC
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Telephone | 509-630-3107
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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