Provider Demographics
NPI:1528551538
Name:HARDING, KIM DALENE (LCPC, LAC, MHPP)
Entity Type:Individual
Prefix:MS
First Name:KIM
Middle Name:DALENE
Last Name:HARDING
Suffix:
Gender:F
Credentials:LCPC, LAC, MHPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:802 MAIN ST STE C
Mailing Address - Street 2:
Mailing Address - City:POLSON
Mailing Address - State:MT
Mailing Address - Zip Code:59860-3200
Mailing Address - Country:US
Mailing Address - Phone:406-883-7310
Mailing Address - Fax:406-883-7212
Practice Address - Street 1:35592 ROCKY POINT RD
Practice Address - Street 2:
Practice Address - City:POLSON
Practice Address - State:MT
Practice Address - Zip Code:59860-9254
Practice Address - Country:US
Practice Address - Phone:520-391-0561
Practice Address - Fax:406-278-6714
Is Sole Proprietor?:No
Enumeration Date:2018-06-13
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LAC-LIC-30316101YA0400X
MTBBH-LCPC-LIC-32044101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)