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General NPI Number Information
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NPI Number | 1336539287
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Entity Type | Individual
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Provider Name | CRYSTAL NOPPENBERG LCSW
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Gender | Female
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Dates
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Enumeration Date | 01/30/2015
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Last Update Date | 11/23/2022
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Provider Practice Location Address
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Address Line | 7300 N PERIMETER RD
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City | MALMSTROM AFB
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State | MT
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Zip | 59402-6701
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Country | US
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Telephone | 406-731-7494
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Fax |
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Provider Business Mailing Address
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Address Line | 2820 5TH AVE S
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City | GREAT FALLS
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State | MT
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Zip | 59405-3143
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Country | US
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Telephone | 406-750-5866
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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 | 8368
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License Number State | MT
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | BBH-LCSW-LIC-8368
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License Number State | MT
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