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General NPI Number Information
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NPI Number | 1437774809
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Entity Type | Organization
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Legal Business Name | CONNECTED BRAIN & BODY BASED COUNSELING LLC
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Dates
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Enumeration Date | 06/11/2020
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Last Update Date | 03/31/2025
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Provider Practice Location Address
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Address Line | 600 CENTRAL AVE STE 225
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City | GREAT FALLS
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State | MT
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Zip | 59401-3157
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Country | US
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Telephone | 406-201-1485
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Fax | 406-403-0312
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Provider Business Mailing Address
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Address Line | 600 CENTRAL AVE STE 302
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City | GREAT FALLS
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State | MT
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Zip | 59401-3141
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KIM BODILY
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Credential | MS, LCPC
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Telephone | 64-209-8747
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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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 | 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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