Healthcare Provider Details

I. General information

NPI: 1598472748
Provider Name (Legal Business Name): BEVERLY SWANEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2022
Last Update Date: 10/27/2022
Certification Date: 10/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35401 MISSION DR
SAINT IGNATIUS MT
59865-7791
US

IV. Provider business mailing address

PO BOX 880
SAINT IGNATIUS MT
59865-0880
US

V. Phone/Fax

Practice location:
  • Phone: 406-745-3525
  • Fax: 406-745-4721
Mailing address:
  • Phone: 406-745-3525
  • Fax: 406-745-4721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberBBH-ACLC-LIC-57081
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberBBH-ACLC-LIC-57081
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: