Healthcare Provider Details

I. General information

NPI: 1336506807
Provider Name (Legal Business Name): CHRISTL STANWOOD LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2016
Last Update Date: 06/29/2020
Certification Date: 06/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HERITAGE WAY
KALISPELL MT
59901-3146
US

IV. Provider business mailing address

308 COUGAR TRL
WHITEFISH MT
59937-8431
US

V. Phone/Fax

Practice location:
  • Phone: 406-752-5111
  • Fax:
Mailing address:
  • Phone: 406-261-6256
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number15794
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: