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General NPI Number Information
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NPI Number | 1306393194
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Entity Type | Organization
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Legal Business Name | DANA EISENBERG, LCSW COUNSELING AND CONSULTATION, LLC
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Dates
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Enumeration Date | 09/08/2016
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Last Update Date | 09/08/2016
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Provider Practice Location Address
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Address Line | 528 CLEVELAND ST
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City | MISSOULA
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State | MT
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Zip | 59801-3743
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Country | US
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Telephone | 406-239-1106
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Fax |
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Provider Business Mailing Address
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Address Line | 528 CLEVELAND ST
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City | MISSOULA
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State | MT
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Zip | 59801-3743
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Country | US
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Telephone | 406-239-1106
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DANA EISENBERG
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Credential | LCSW
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Telephone | 406-239-1106
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | LCSW 580
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License Number State | MT
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