Provider Demographics
NPI:1841749249
Name:KICKIN IT ENTERPRISES
Entity Type:Organization
Organization Name:KICKIN IT ENTERPRISES
Other - Org Name:DALRYMPLE COUNSELING SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:GINA
Authorized Official - Middle Name:L
Authorized Official - Last Name:DALRYMPLE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:406-883-1718
Mailing Address - Street 1:1201 MAIN ST
Mailing Address - Street 2:B
Mailing Address - City:POLSON
Mailing Address - State:MT
Mailing Address - Zip Code:59860-5328
Mailing Address - Country:US
Mailing Address - Phone:406-883-1718
Mailing Address - Fax:406-204-1207
Practice Address - Street 1:1201 MAIN ST
Practice Address - Street 2:B
Practice Address - City:POLSON
Practice Address - State:MT
Practice Address - Zip Code:59860-5328
Practice Address - Country:US
Practice Address - Phone:406-883-1718
Practice Address - Fax:406-204-1207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-26
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT23971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty