Provider Demographics
NPI:1568526390
Name:WHITEPINE COUNSELING SERVICES P C
Entity Type:Organization
Organization Name:WHITEPINE COUNSELING SERVICES P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:LARSON
Authorized Official - Last Name:BABCOCK
Authorized Official - Suffix:
Authorized Official - Credentials:MED, LCPC
Authorized Official - Phone:406-586-8030
Mailing Address - Street 1:104 E MAIN ST
Mailing Address - Street 2:STE 302
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-4760
Mailing Address - Country:US
Mailing Address - Phone:406-586-8038
Mailing Address - Fax:
Practice Address - Street 1:104 E MAIN ST
Practice Address - Street 2:STE 302
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-4760
Practice Address - Country:US
Practice Address - Phone:406-586-8038
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT451261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTBCBS #07527-3OtherBLUE CROSS BLUE SHIELD
MT0000255051Medicaid
MT========= 59715 A001OtherTRICARE