=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336506807
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHRISTL STANWOOD LCPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/28/2016
-----------------------------------------------------
Last Update Date | 06/29/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 200 HERITAGE WAY
-----------------------------------------------------
City | KALISPELL
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59901-3146
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-752-5111
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 308 COUGAR TRL
-----------------------------------------------------
City | WHITEFISH
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59937-8431
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-261-6256
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 15794
-----------------------------------------------------
License Number State | MT
-----------------------------------------------------