Provider Demographics
NPI:1952809154
Name:MOUNTAIN ROSE COUNSELING
Entity Type:Organization
Organization Name:MOUNTAIN ROSE COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST/COUNSELOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KIRSTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KOENIG
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC, CMHP
Authorized Official - Phone:406-293-5768
Mailing Address - Street 1:1222 MINNESOTA AVE
Mailing Address - Street 2:
Mailing Address - City:LIBBY
Mailing Address - State:MT
Mailing Address - Zip Code:59923-2306
Mailing Address - Country:US
Mailing Address - Phone:406-293-5768
Mailing Address - Fax:406-293-2832
Practice Address - Street 1:1222 MINNESOTA AVE
Practice Address - Street 2:
Practice Address - City:LIBBY
Practice Address - State:MT
Practice Address - Zip Code:59923-2306
Practice Address - Country:US
Practice Address - Phone:406-293-5768
Practice Address - Fax:406-293-2832
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MOUNTAIN ROSE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-01-23
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LCPC-LIC-15792101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty