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General NPI Number Information
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NPI Number | 1134896061
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Entity Type | Organization
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Legal Business Name | WHITE BUFFALO STAR, INC
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Dates
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Enumeration Date | 08/27/2021
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Last Update Date | 07/11/2025
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Provider Practice Location Address
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Address Line | 113 S. FIRST ST
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City | ENNIS
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State | MT
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Zip | 59729
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Country | US
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Telephone | 707-228-6359
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Fax |
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Provider Business Mailing Address
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Address Line | 4820 VENETIAN BLVD NE
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City | ST PETERSBURG
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State | FL
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Zip | 33703-4228
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Country | US
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Telephone | 707-228-6359
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Fax | 406-215-4643
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Authorized Official
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Title or Position | OWNER
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Name | DARCY DOBB
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Credential | LCSW
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Telephone | 707-228-6359
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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