Healthcare Provider Details

I. General information

NPI: 1912225061
Provider Name (Legal Business Name): CARLA A. GRUNDHAUSER LCSW, LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CARLA A CASTRO LCPC

II. Dates (important events)

Enumeration Date: 05/13/2010
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

918 2ND AVE
LAUREL MT
59044-2017
US

IV. Provider business mailing address

918 2ND AVE
LAUREL MT
59044-2017
US

V. Phone/Fax

Practice location:
  • Phone: 701-561-6033
  • Fax:
Mailing address:
  • Phone: 701-561-6033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberBBH-LCPC-LIC-43588
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberBBH-LCSW-LIC-85523
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: