Healthcare Provider Details

I. General information

NPI: 1568716090
Provider Name (Legal Business Name): NORTHERN CHEYENNE TRIBE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2012
Last Update Date: 04/26/2024
Certification Date: 04/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 NORTH CHEYENNE AVENUE LAME DEER HEALTH CENTER - BEHAVIOR HEALTH
LAME DEER MT
59043
US

IV. Provider business mailing address

PO BOX 128 600 CHEYENNE AVE SOUTH
LAME DEER MT
59043-0128
US

V. Phone/Fax

Practice location:
  • Phone: 406-477-4514
  • Fax: 406-477-4513
Mailing address:
  • Phone: 406-477-6722
  • Fax: 406-477-8621

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 Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: MARIA ROUNDSTONE
Title or Position: DIRECTOR OF REVENUE ENHANCEMENT
Credential:
Phone: 406-477-6722