Flourish Counseling Mt, LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

FLOURISH COUNSELING MT, LLC

Practice address

2135 Charlotte St Ste 2
Bozeman, MT 59718-2741

Phone

(206) 930-8970

NPI assigned

Jun 7, 2019

Last updated

Dec 8, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jai Kieron Rene Russell, LCSWNPI 1972162683

Title

Clinical Social Worker

Phone

(206) 930-8970

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jai Kieron Rene Russell, LCSW

  • Clinical Social Worker
  • Bozeman, MT
  • NPI 1972162683
  Authorized official Same address or phone

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

{
    "created_epoch": "1559865600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1638921600000",
    "number": "1063071645",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 385",
            "city": "BOZEMAN",
            "state": "MT",
            "postal_code": "597710385",
            "telephone_number": "206-930-8970"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2135 CHARLOTTE ST STE 2",
            "city": "BOZEMAN",
            "state": "MT",
            "postal_code": "597182741",
            "telephone_number": "206-930-8970"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FLOURISH COUNSELING MT, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-07",
        "last_updated": "2021-12-08",
        "certification_date": "2021-12-08",
        "status": "A",
        "authorized_official_last_name": "RUSSELL",
        "authorized_official_first_name": "JAI",
        "authorized_official_middle_name": "KIERON RENE",
        "authorized_official_title_or_position": "CLINICAL SOCIAL WORKER",
        "authorized_official_telephone_number": "206-930-8970",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in Bozeman, MT
• Providers in Bozeman, MT by specialty
• Clinical Social Worker in Montana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.