MEDICARE: AGAINST THE GRAIN PSYCHOTHERAPY PLLC

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	:	1760279335
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AGAINST THE GRAIN PSYCHOTHERAPY PLLC

Provider Business Mailing Address
First Line	:	1135 STRAND AVE STE B
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59801-5678
Country	:	US
Telephone Number	:	406-475-6922
Fax Number	:	406-258-0461

Provider Business Practice Location Address
First Line	:	1135 STRAND AVE STE B
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59801-5678
Country	:	US
Telephone Number	:	406-475-6922
Fax Number	:	406-258-0461

Authorized Official
Title or Position	:	SOLE MEMBER
Name	:	VALERIE COULTER
Credential	:	LCSW
Telephone Number	:	406-475-6922

Provider Enumeration Date	:	04/24/2025
Last Update Date	:	04/24/2025

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