Provider Demographics
NPI:1578635793
Name:BELGRADE COUNSELING CLINIC, INC
Entity Type:Organization
Organization Name:BELGRADE COUNSELING CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:
Authorized Official - Last Name:WATTS
Authorized Official - Suffix:
Authorized Official - Credentials:MED, LCPC
Authorized Official - Phone:406-388-7174
Mailing Address - Street 1:PO BOX 1377
Mailing Address - Street 2:
Mailing Address - City:BELGRADE
Mailing Address - State:MT
Mailing Address - Zip Code:59714-1377
Mailing Address - Country:US
Mailing Address - Phone:406-388-7174
Mailing Address - Fax:406-388-4958
Practice Address - Street 1:129 VILLAGE DR STE 303
Practice Address - Street 2:
Practice Address - City:BELGRADE
Practice Address - State:MT
Practice Address - Zip Code:59714-9618
Practice Address - Country:US
Practice Address - Phone:406-388-7174
Practice Address - Fax:406-388-4958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT597 LCPC101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0254796Medicaid
MT07539-5OtherBLUE CROSS BLUE SHIELD #