Provider Demographics
NPI:1528218617
Name:REACHING AHEAD PLLC
Entity Type:Organization
Organization Name:REACHING AHEAD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:HERZOG
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:406-587-3404
Mailing Address - Street 1:2018 STADIUM DR STE B
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-0706
Mailing Address - Country:US
Mailing Address - Phone:406-587-3404
Mailing Address - Fax:
Practice Address - Street 1:2018 STADIUM DR STE B
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-0706
Practice Address - Country:US
Practice Address - Phone:406-587-3404
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-24
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1334-LCPC251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1334-LCPCOtherLCPC-MONTANA