Healthcare Provider Details

I. General information

NPI: 1194717546
Provider Name (Legal Business Name): LESLIE MARIE STERLING LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 02/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 MONTANA AVE
LIBBY MT
59923-2039
US

IV. Provider business mailing address

PO BOX 1838
EUREKA MT
59917-1838
US

V. Phone/Fax

Practice location:
  • Phone: 303-909-1573
  • Fax:
Mailing address:
  • Phone: 303-909-1573
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number991958
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number22836
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: