Healthcare Provider Details

I. General information

NPI: 1205041621
Provider Name (Legal Business Name): FORT BELKNAP INDIAN COMMUNITY TRIBAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 09/05/2023
Certification Date: 09/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

656 AGENCY MAIN ST
HARLEM MT
59526
US

IV. Provider business mailing address

656 AGENCY MAIN STREET
HARLEM MT
59526
US

V. Phone/Fax

Practice location:
  • Phone: 406-353-2525
  • Fax: 406-353-2884
Mailing address:
  • Phone: 406-353-2525
  • Fax: 406-353-3308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER SHOW
Title or Position: CHIEF HEALTH OFFICER
Credential:
Phone: 406-353-3246