# FLOURISH COUNSELING MT, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1063071645
- **Authorized official:** JAI KIERON RENE RUSSELL LCSW (CLINICAL SOCIAL WORKER)
- **Authorized official phone:** (206) 930-8970

## Contact information

- **Practice address:** 2135 CHARLOTTE ST STE 2, BOZEMAN, MT 59718-2741
- **Practice address phone:** (206) 930-8970
- **Mailing address:** PO BOX 385, BOZEMAN, MT 59771-0385
- **Mailing address phone:** (206) 930-8970

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1041C0700X | Clinical Social Worker | — | NULL | Yes |
| 1041C0700X | Clinical Social Worker | — | — | Yes |

## Other

- **Enumeration date:** 06/07/2019
- **Last updated:** 12/08/2021