Provider Demographics
NPI:1811572647
Name:FAMILY COUNSELING CENTER OF MT
Entity Type:Organization
Organization Name:FAMILY COUNSELING CENTER OF MT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:FAHLSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:406-219-1350
Mailing Address - Street 1:PO BOX 7003
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59771-7003
Mailing Address - Country:US
Mailing Address - Phone:406-219-1350
Mailing Address - Fax:
Practice Address - Street 1:145 MILL TOWN LOOP STE B
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-5144
Practice Address - Country:US
Practice Address - Phone:406-219-1350
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-12
Last Update Date:2021-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health