Healthcare Provider Details

I. General information

NPI: 1427793314
Provider Name (Legal Business Name): LINDA YEAROUS MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2022
Last Update Date: 09/08/2023
Certification Date: 09/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2237 S 3RD ST W
MISSOULA MT
59801-1334
US

IV. Provider business mailing address

2237 S 3RD ST W
MISSOULA MT
59801-1334
US

V. Phone/Fax

Practice location:
  • Phone: 406-201-5223
  • Fax:
Mailing address:
  • Phone: 406-201-5223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberBBH-SWLC-LIC-31679
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberBBH-LCSW-LIC-64382
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: