Provider Demographics
NPI:1265094601
Name:BODHI TREE COUNSELING, INC
Entity type:Organization
Organization Name:BODHI TREE COUNSELING, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:CHURCH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, LAC
Authorized Official - Phone:406-694-5000
Mailing Address - Street 1:540 JEMSTONE DR
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59101-6854
Mailing Address - Country:US
Mailing Address - Phone:406-694-5000
Mailing Address - Fax:
Practice Address - Street 1:527 LAKE ELMO DR
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59105-3051
Practice Address - Country:US
Practice Address - Phone:406-694-5000
Practice Address - Fax:406-245-1156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-06
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1265094601Medicaid