Healthcare Provider Details

I. General information

NPI: 1235666488
Provider Name (Legal Business Name): STELLINGWERF, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2017
Last Update Date: 11/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

914 20TH ST S
GREAT FALLS MT
59405-2743
US

IV. Provider business mailing address

914 20TH ST S
GREAT FALLS MT
59405-2743
US

V. Phone/Fax

Practice location:
  • Phone: 406-272-4545
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberBBH-LCPC-LIC-17854
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: SANDRA RYANNE STELLINGWERF
Title or Position: SOLE OWNER
Credential: LCPC
Phone: 406-272-4545