MEDICARE: GUIDED HEALING TRAILS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	101YP2500X	Professional Counselor
3	251B00000X	Case Management Agency
4	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center
5	261QR0401X	Comprehensive Outpatient Rehabilitation Facility (CORF)

General Provider Information

NPI Number	:	1033678396
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GUIDED HEALING TRAILS LLC

Provider Business Mailing Address
First Line	:	500 N HIGGINS AVE STE 107
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59802-4550
Country	:	US
Telephone Number	:	406-540-4120
Fax Number	:	406-540-4160

Provider Business Practice Location Address
First Line	:	913 SW HIGGINS AVE STE 201
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59803-1423
Country	:	US
Telephone Number	:	406-540-4120
Fax Number	:	406-540-4160

Authorized Official
Title or Position	:	FAMILY THERAPIST/OWNER
Name	:	MR. JOSEPH BRENT SUCHANIC
Credential	:	LMFT, LCPC
Telephone Number	:	406-540-4120

Provider Enumeration Date	:	03/17/2019
Last Update Date	:	09/07/2023

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