MEDICARE: MICHAEL STEMBORSKI LCPC, LAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	1183	MT
2	101YM0800X	Mental Health Counselor	1103	MT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	742670	OTHER	MT	BLUE CROSS

General Provider Information

NPI Number	:	1194762401
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL STEMBORSKI LCPC, LAC

Provider Business Mailing Address
First Line	:	1611 N FORK RD
Second Line	:	SUITE 100
City	:	COLUMBIA FALLS
State	:	MT
Zip	:	59912-9410
Country	:	US
Telephone Number	:	406-892-8830
Fax Number	:

Provider Business Practice Location Address
First Line	:	1611 N FORK RD
Second Line	:	SUITE 100
City	:	COLUMBIA FALLS
State	:	MT
Zip	:	59912-9410
Country	:	US
Telephone Number	:	406-892-8830
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2006
Last Update Date	:	01/30/2025

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