Willow Canyon Counseling Services

Primary specialty

Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X

License

BBH-LAC-LIC-1275 Issued in MT

Legal business name

WILLOW CANYON COUNSELING SERVICES

Practice address

302 1St St W Ste 203
Polson, MT 59860-2602

Phone

(406) 270-3447

NPI assigned

Jan 3, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Shaunda Marie Albert, LCSW , LAC, MACNPI 1912407198

Title

Owner

Phone

(406) 260-5085

Specialties & licenses 3

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in MT

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Shaunda Marie Albert, LAC, MAC, LCSW

  • Addiction (Substance Use Disorder) Counselor
  • Polson, MT
  • NPI 1912407198

  Clinical

  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1514937600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1643932800000",
    "number": "1023525771",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "42522 CANAL RD",
            "city": "RONAN",
            "state": "MT",
            "postal_code": "598649002",
            "telephone_number": "406-260-5085"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "302 1ST ST W STE 203",
            "city": "POLSON",
            "state": "MT",
            "postal_code": "598602602",
            "telephone_number": "406-270-3447"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLOW CANYON COUNSELING SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-03",
        "last_updated": "2022-02-04",
        "certification_date": "2022-02-02",
        "status": "A",
        "authorized_official_last_name": "ALBERT",
        "authorized_official_first_name": "SHAUNDA",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "406-260-5085",
        "authorized_official_credential": "LCSW  ,  LAC, MAC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": "MT",
            "license": "BBH-SWLC-LIC-17314",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "MT",
            "license": "BBH-LAC-LIC-1275",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "willowcanyoncounseling@ronan.net",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "302 1st St W Ste 203",
            "city": "Polson",
            "state": "MT",
            "country_code": "US",
            "postal_code": "598602602",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Substance Use Disorder Rehabilitation Clinic/Center in Polson, MT
• Providers in Polson, MT by specialty
• Substance Use Disorder Rehabilitation Clinic/Center in Montana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.