| Flourish Counseling Mt, Llc | |
|
2135 Charlotte St Ste 2 Bozeman MT 59718-2741 | |
| (206) 930-8970 | |
| Not Available |
| Full Name | Flourish Counseling Mt, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 2135 Charlotte St Ste 2, Bozeman, Montana |
| Authorized Official Name and Position | Jai Kieron Rene Russell (CLINICAL SOCIAL WORKER) |
| Authorized Official Contact | 2069308970 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Flourish Counseling Mt, Llc Po Box 385 Bozeman MT 59771-0385 Ph: (206) 930-8970 | Flourish Counseling Mt, Llc 2135 Charlotte St Ste 2 Bozeman MT 59718-2741 Ph: (206) 930-8970 |
| NPI Number | 1063071645 |
|---|---|
| Provider Enumeration Date | 06/07/2019 |
| Last Update Date | 12/08/2021 |
| Certification Date | 12/08/2021 |
| Medicare PECOS PAC ID | 3870820459 |
|---|---|
| Medicare Enrollment ID | O20190805001876 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063071645 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Jai Kieron Rene Anderson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1972162683 PECOS PAC ID: 6305171679 Enrollment ID: I20190709000966 |
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