=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225412919
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | YELLOWSTONE VALLEY BEHAVIORAL HEALTH, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/13/2015
-----------------------------------------------------
Last Update Date | 07/13/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 490 N 31ST ST STE 110
-----------------------------------------------------
City | BILLINGS
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59101-1256
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-969-2273
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 490 N 31ST ST STE 110
-----------------------------------------------------
City | BILLINGS
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59101-1256
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-969-2273
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | THERAPIST
-----------------------------------------------------
Name | MR. STEPHEN J BURROWS
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 406-969-2273
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | LAC-LAC-LIC-1424
-----------------------------------------------------
License Number State | MT
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | SWP-LCSW-LIC-4449
-----------------------------------------------------
License Number State | MT
-----------------------------------------------------