Provider Demographics
NPI:1356910210
Name:KINTSUGI COUNSELING PLLC
Entity type:Organization
Organization Name:KINTSUGI COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:406-868-0228
Mailing Address - Street 1:1601 2ND AVE N STE 200A
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59401-3243
Mailing Address - Country:US
Mailing Address - Phone:406-868-0227
Mailing Address - Fax:877-828-5889
Practice Address - Street 1:1601 2ND AVE N STE 200A
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59401-3243
Practice Address - Country:US
Practice Address - Phone:406-868-0228
Practice Address - Fax:877-828-5889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-23
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No282J00000XHospitalsReligious Nonmedical Health Care InstitutionGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT11111Medicaid