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General NPI Number Information
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NPI Number | 1477316347
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Entity Type | Organization
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Legal Business Name | BOZEMAN SUPPORTIVE COUNSELING
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Dates
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Enumeration Date | 02/02/2024
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Last Update Date | 03/26/2025
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Provider Practice Location Address
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Address Line | 337 1ST AVE E
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City | KALISPELL
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State | MT
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Zip | 59901-4935
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Country | US
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Telephone | 406-813-1621
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 69
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City | BINGEN
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State | WA
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Zip | 98605-0069
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Country | US
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Telephone | 406-813-1621
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Fax |
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Authorized Official
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Title or Position | LCPC
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Name | MS. MOLLY JO BASTA
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Credential | LCPC
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Telephone | 406-813-1621
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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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