Healthcare Provider Details

I. General information

NPI: 1366742199
Provider Name (Legal Business Name): NATHAN L CHURCH LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2010
Last Update Date: 04/16/2020
Certification Date: 04/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

527 LAKE ELMO DR
BILLINGS MT
59105-3051
US

IV. Provider business mailing address

540 JEMSTONE DR
BILLINGS MT
59101-6854
US

V. Phone/Fax

Practice location:
  • Phone: 406-694-5000
  • Fax: 406-245-1156
Mailing address:
  • Phone: 406-694-5000
  • Fax: 406-245-1156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1352
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1043
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: