Provider Demographics
NPI:1023525771
Name:WILLOW CANYON COUNSELING SERVICES
Entity type:Organization
Organization Name:WILLOW CANYON COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAUNDA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:ALBERT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW , LAC, MAC
Authorized Official - Phone:406-260-5085
Mailing Address - Street 1:42522 CANAL RD
Mailing Address - Street 2:
Mailing Address - City:RONAN
Mailing Address - State:MT
Mailing Address - Zip Code:59864-9002
Mailing Address - Country:US
Mailing Address - Phone:406-260-5085
Mailing Address - Fax:
Practice Address - Street 1:302 1ST ST W STE 203
Practice Address - Street 2:
Practice Address - City:POLSON
Practice Address - State:MT
Practice Address - Zip Code:59860-2602
Practice Address - Country:US
Practice Address - Phone:406-270-3447
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-03
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-SWLC-LIC-17314101YM0800X
1041C0700X
MTBBH-LAC-LIC-1275261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty