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General NPI Number Information
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NPI Number | 1245665116
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Entity Type | Individual
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Provider Name | WAKEFIELD H TROY LCSW
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Gender | Male
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Dates
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Enumeration Date | 09/10/2013
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Last Update Date | 12/08/2025
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Provider Practice Location Address
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Address Line | 305 1ST AVE W
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City | COLUMBIA FLS
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State | MT
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Zip | 59912-3625
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Country | US
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Telephone | 406-871-3725
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Fax |
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Provider Business Mailing Address
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Address Line | 138 2ND AVE E
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City | COLUMBIA FLS
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State | MT
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Zip | 59912-3318
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Country | US
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Telephone | 406-871-3725
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | LW70006559
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 4439
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License Number State | MT
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