Healthcare Provider Details

I. General information

NPI: 1730737149
Provider Name (Legal Business Name): SHERIDAN JOHN GROUND A.C.L.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2019
Last Update Date: 11/27/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 POPIMI ST
BROWNING MT
59417-5315
US

IV. Provider business mailing address

503 POPIMI ST
BROWNING MT
59417-5315
US

V. Phone/Fax

Practice location:
  • Phone: 406-338-3948
  • Fax:
Mailing address:
  • Phone: 406-338-3948
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number23070
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: