Provider Demographics
NPI:1043775612
Name:ECHO LAKE COUNSELING
Entity Type:Organization
Organization Name:ECHO LAKE COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATTI
Authorized Official - Middle Name:
Authorized Official - Last Name:SALOMONSEN
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:406-565-6491
Mailing Address - Street 1:1715 FIR CREST CT
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-7413
Mailing Address - Country:US
Mailing Address - Phone:406-565-6491
Mailing Address - Fax:
Practice Address - Street 1:411 W MENDENHALL ST
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-3404
Practice Address - Country:US
Practice Address - Phone:406-565-6491
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-07
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1477745370Medicaid