Healthcare Provider Details

I. General information

NPI: 1740350461
Provider Name (Legal Business Name): NANCY M SMITH MSW, LCSW, LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 10/07/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 4TH AVE E
SUPERIOR MT
59872-3075
US

IV. Provider business mailing address

89 MILL CREEK RD
SAINT REGIS MT
59866-9710
US

V. Phone/Fax

Practice location:
  • Phone: 406-822-5422
  • Fax: 406-324-7062
Mailing address:
  • Phone: 406-649-2761
  • Fax: 406-822-5423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number635
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number765
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: