Provider Demographics
NPI:1447767280
Name:AMBRE'S BRIDGE COUNSELING AND CONSULTING PLLC
Entity Type:Organization
Organization Name:AMBRE'S BRIDGE COUNSELING AND CONSULTING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER, CEO, CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:KRISTINA
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:GROVHOUG
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:406-637-3206
Mailing Address - Street 1:600 CENTRAL AVE STE 305
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59401-3157
Mailing Address - Country:US
Mailing Address - Phone:406-637-3204
Mailing Address - Fax:
Practice Address - Street 1:600 CENTRAL AVE STE 305
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59401-3157
Practice Address - Country:US
Practice Address - Phone:406-637-3204
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-02
Last Update Date:2018-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LCSW-LIC-291821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty