Healthcare Provider Details

I. General information

NPI: 1982149589
Provider Name (Legal Business Name): TODD CARDIN MSW, LCSW, LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2017
Last Update Date: 09/17/2021
Certification Date: 09/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1103 S MAIN ST
KALISPELL MT
59901-5674
US

IV. Provider business mailing address

PO BOX 2226
KALISPELL MT
59903-2226
US

V. Phone/Fax

Practice location:
  • Phone: 406-250-3960
  • Fax:
Mailing address:
  • Phone: 406-250-3960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLAC-LAC-LIC-868
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number19760
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: