MEDICARE: BIRCH BRANCH THERAPY

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1225988165
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BIRCH BRANCH THERAPY

Provider Business Mailing Address
First Line	:	337 1ST AVE E
Second Line	:
City	:	KALISPELL
State	:	MT
Zip	:	59901-4935
Country	:	US
Telephone Number	:	406-253-7038
Fax Number	:

Provider Business Practice Location Address
First Line	:	337 1ST AVE E
Second Line	:
City	:	KALISPELL
State	:	MT
Zip	:	59901-4935
Country	:	US
Telephone Number	:	406-253-7038
Fax Number	:

Authorized Official
Title or Position	:	OWNER AND PROVIDER
Name	:	JESSICA KAY BAMBOCK
Credential	:	MSW, LCSW
Telephone Number	:	406-253-7038

Provider Enumeration Date	:	01/30/2026
Last Update Date	:	01/30/2026

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Directions to “BIRCH BRANCH THERAPY ” Practice Location

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