Healthcare Provider Details

I. General information

NPI: 1649300567
Provider Name (Legal Business Name): SOUTHWEST CHEMICAL DEPENDENCY PROGRAM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 09/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 E PARK ST
LIVINGSTON MT
59047-2755
US

IV. Provider business mailing address

PO BOX 1587
LIVINGSTON MT
59047-5587
US

V. Phone/Fax

Practice location:
  • Phone: 406-222-2812
  • Fax: 406-222-4764
Mailing address:
  • Phone: 406-222-2812
  • Fax: 406-222-4764

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number089288
License Number StateMT

VIII. Authorized Official

Name: JEAN E. MCCAULEY
Title or Position: PROGRAM DIRECTOR
Credential: L.A.C.
Phone: 406-222-2812