| Brave Roots Counseling, Llc | |
|
944 Avenue B Billings MT 59102-3346 | |
| (406) 272-2532 | |
| Not Available |
| Full Name | Brave Roots Counseling, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 944 Avenue B, Billings, Montana |
| Authorized Official Name and Position | Kaela Imm (OWNER) |
| Authorized Official Contact | 4062722532 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Brave Roots Counseling, Llc Po Box 22214 Billings MT 59104-2214 Ph: (406) 272-2532 | Brave Roots Counseling, Llc 944 Avenue B Billings MT 59102-3346 Ph: (406) 272-2532 |
| NPI Number | 1760071831 |
|---|---|
| Provider Enumeration Date | 01/13/2021 |
| Last Update Date | 01/13/2021 |
| Certification Date | 01/13/2021 |
| Medicare PECOS PAC ID | 0941616759 |
|---|---|
| Medicare Enrollment ID | O20210302002905 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760071831 | NPI | - | NPPES |
| 1679169585 | Medicaid | MT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Kaela D Imm |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1679169585 PECOS PAC ID: 1850707662 Enrollment ID: I20210302002942 |
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