Provider Demographics
NPI:1356642904
Name:FULL CIRCLE COUNSELING SOLUTIONS
Entity Type:Organization
Organization Name:FULL CIRCLE COUNSELING SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:GILLISPIE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:406-529-9516
Mailing Address - Street 1:1501 NORTH AVE W
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-5503
Mailing Address - Country:US
Mailing Address - Phone:406-529-9516
Mailing Address - Fax:406-523-1616
Practice Address - Street 1:1501 NORTH AVE W
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-5503
Practice Address - Country:US
Practice Address - Phone:406-529-9516
Practice Address - Fax:406-523-1616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-13
Last Update Date:2010-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT9641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty