Provider Demographics
NPI:1487356424
Name:CLARK CITY COUNSELING
Entity type:Organization
Organization Name:CLARK CITY COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PROPRIETOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:SWLC, LAC
Authorized Official - Phone:406-220-6204
Mailing Address - Street 1:117 S 10TH ST
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:MT
Mailing Address - Zip Code:59047-2519
Mailing Address - Country:US
Mailing Address - Phone:406-671-8900
Mailing Address - Fax:
Practice Address - Street 1:1201 US HIGHWAY 10 W STE A4D
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:MT
Practice Address - Zip Code:59047-9022
Practice Address - Country:US
Practice Address - Phone:406-220-6204
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-21
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health