Healthcare Provider Details

I. General information

NPI: 1881608578
Provider Name (Legal Business Name): SUE ANNE TANNER WORKMAN POLLINGTON PHD, LCSW, LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUE ANNE WORKMAN PHD. LCSW, LAC

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 05/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1023 5TH ST
HAVRE MT
59501-4106
US

IV. Provider business mailing address

1023 5TH ST
HAVRE MT
59501-4106
US

V. Phone/Fax

Practice location:
  • Phone: 406-217-5222
  • Fax:
Mailing address:
  • Phone: 406-217-5222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1253
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number352 LCSW
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: