Healthcare Provider Details

I. General information

NPI: 1205611969
Provider Name (Legal Business Name): SHERL SHANKS ACLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2023
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 1/2 COURT AVE.
POPLAR MT
59255
US

IV. Provider business mailing address

603 1/2 COURT AVE.
POPLAR MT
59255
US

V. Phone/Fax

Practice location:
  • Phone: 406-768-3852
  • Fax: 406-768-5202
Mailing address:
  • Phone: 406-768-3852
  • Fax: 406-768-5202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberBBH-ACLC-LIC-50178
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: