Provider Demographics
NPI:1265260285
Name:GLACIER TRAILS COUNSELING LLC
Entity type:Organization
Organization Name:GLACIER TRAILS COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:TERRAN
Authorized Official - Middle Name:
Authorized Official - Last Name:EASTHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-414-9623
Mailing Address - Street 1:PO BOX 16331
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59808-6331
Mailing Address - Country:US
Mailing Address - Phone:406-414-9623
Mailing Address - Fax:
Practice Address - Street 1:2601 S 3RD ST W
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59804-1143
Practice Address - Country:US
Practice Address - Phone:406-414-9623
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-22
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty