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General NPI Number Information
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NPI Number | 1447767280
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Entity Type | Organization
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Legal Business Name | AMBRE'S BRIDGE COUNSELING AND CONSULTING PLLC
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Dates
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Enumeration Date | 01/02/2018
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Last Update Date | 01/05/2018
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Provider Practice Location Address
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Address Line | 600 CENTRAL AVE STE 305
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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 | 406-637-3204
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Fax |
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Provider Business Mailing Address
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Address Line | 600 CENTRAL AVE STE 305
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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 | 406-637-3204
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Fax |
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Authorized Official
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Title or Position | FOUNDER, CEO, CLINICIAN
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Name | KRISTINA DAWN GROVHOUG
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Credential | LCSW
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Telephone | 406-637-3206
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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 | BBH-LCSW-LIC-29182
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License Number State | MT
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