MEDICARE: LOW TIDE COUNSELING

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1972204576
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOW TIDE COUNSELING

Provider Business Mailing Address
First Line	:	825 GREAT NORTHERN BLVD STE 327
Second Line	:
City	:	HELENA
State	:	MT
Zip	:	59601-3340
Country	:	US
Telephone Number	:	406-719-6878
Fax Number	:

Provider Business Practice Location Address
First Line	:	825 GREAT NORTHERN BLVD STE 327
Second Line	:
City	:	HELENA
State	:	MT
Zip	:	59601-3340
Country	:	US
Telephone Number	:	406-719-6878
Fax Number	:

Authorized Official
Title or Position	:	THERAPIST
Name	:	KATELYN WILSON
Credential	:	LCPC
Telephone Number	:	406-422-9812

Provider Enumeration Date	:	03/13/2023
Last Update Date	:	07/06/2023

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Directions to “LOW TIDE COUNSELING ” Practice Location

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