Provider Demographics
NPI:1992289284
Name:PARKSIDE COUNSELING, LC
Entity type:Organization
Organization Name:PARKSIDE COUNSELING, LC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CORY
Authorized Official - Middle Name:
Authorized Official - Last Name:KOHM
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:406-250-6225
Mailing Address - Street 1:926 2ND ST E
Mailing Address - Street 2:
Mailing Address - City:WHITEFISH
Mailing Address - State:MT
Mailing Address - Zip Code:59937-2608
Mailing Address - Country:US
Mailing Address - Phone:406-250-6225
Mailing Address - Fax:
Practice Address - Street 1:926 2ND ST E
Practice Address - Street 2:
Practice Address - City:WHITEFISH
Practice Address - State:MT
Practice Address - Zip Code:59937-2608
Practice Address - Country:US
Practice Address - Phone:406-250-6225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-21
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty