Provider Demographics
NPI:1063056489
Name:46 NORTH COUNSELING LLC
Entity type:Organization
Organization Name:46 NORTH COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALEECE
Authorized Official - Middle Name:JOLENE
Authorized Official - Last Name:BERG
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, LAC
Authorized Official - Phone:406-461-1693
Mailing Address - Street 1:891 STAR RD
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59602-8137
Mailing Address - Country:US
Mailing Address - Phone:406-461-1693
Mailing Address - Fax:
Practice Address - Street 1:1305 11TH AVE
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-3919
Practice Address - Country:US
Practice Address - Phone:406-431-2908
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-29
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1720306848Medicaid