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General NPI Number Information
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NPI Number | 1306453584
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Entity Type | Organization
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Legal Business Name | JOHN SHEEHAN LCSW LLC
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Dates
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Enumeration Date | 09/30/2020
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Last Update Date | 09/30/2020
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Provider Practice Location Address
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Address Line | 520 S 3RD ST W
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City | MISSOULA
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State | MT
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Zip | 59801-2518
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Country | US
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Telephone | 406-209-8826
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 5631
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City | MISSOULA
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State | MT
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Zip | 59806-5631
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Country | US
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Telephone | 406-396-5179
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. JOHN EDWARD SHEEHAN III
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Credential | LCSW
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Telephone | 406-396-5179
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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 |
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License Number State |
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