Provider Demographics
NPI:1548088354
Name:CHICKADEE WISDOM
Entity type:Organization
Organization Name:CHICKADEE WISDOM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GINGER
Authorized Official - Middle Name:L
Authorized Official - Last Name:GOES AHEAD
Authorized Official - Suffix:
Authorized Official - Credentials:MED, LCPC, LAC
Authorized Official - Phone:406-282-2234
Mailing Address - Street 1:2048 OVERLAND AVE STE 102A
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-7428
Mailing Address - Country:US
Mailing Address - Phone:406-282-2234
Mailing Address - Fax:
Practice Address - Street 1:2048 OVERLAND AVE STE 102A
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-7428
Practice Address - Country:US
Practice Address - Phone:406-282-2234
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-30
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchoolGroup - Multi-Specialty