Provider Demographics
NPI:1427604354
Name:EASTERN FRONT COUNSELING LLC
Entity Type:Organization
Organization Name:EASTERN FRONT COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARPENTER
Authorized Official - Suffix:
Authorized Official - Credentials:SWLC LAC
Authorized Official - Phone:406-278-0440
Mailing Address - Street 1:600 S MAIN ST STE 10
Mailing Address - Street 2:
Mailing Address - City:CONRAD
Mailing Address - State:MT
Mailing Address - Zip Code:59425-2532
Mailing Address - Country:US
Mailing Address - Phone:406-278-0440
Mailing Address - Fax:406-278-0330
Practice Address - Street 1:600 S MAIN ST STE 10
Practice Address - Street 2:
Practice Address - City:CONRAD
Practice Address - State:MT
Practice Address - Zip Code:59425-2532
Practice Address - Country:US
Practice Address - Phone:406-278-0440
Practice Address - Fax:406-278-0330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-15
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use DisorderGroup - Multi-Specialty