Healthcare Provider Details

I. General information

NPI: 1982524880
Provider Name (Legal Business Name): DEMI BIANCA CISSELL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DEMI BIANCA HAGLER LCSW

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 E MAIN ST STE 417
BOZEMAN MT
59715-5045
US

IV. Provider business mailing address

233 E MAIN ST STE 417
BOZEMAN MT
59715-5045
US

V. Phone/Fax

Practice location:
  • Phone: 561-317-4563
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number117528
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW009821
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberBBH-LCSW-LIC-90152
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: