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General NPI Number Information
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NPI Number | 1013081637
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Entity Type | Organization
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Legal Business Name | CAMILLA O. BERGSTROM LCSW PC
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Dates
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Enumeration Date | 11/17/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 208 N 29TH ST SUITES 236-237
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City | BILLINGS
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State | MT
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Zip | 59101-1985
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Country | US
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Telephone | 406-899-1008
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Fax |
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Provider Business Mailing Address
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Address Line | 533 EVANS RICEVILLE RD
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City | BELT
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State | MT
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Zip | 59412-8400
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Country | US
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Telephone | 406-736-5613
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. CAMILLA O. HURD
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Credential | LCSW
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Telephone | 406-736-5613
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 327
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License Number State | MT
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