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General NPI Number Information
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NPI Number | 1518201102
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Entity Type | Organization
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Legal Business Name | BLACKFEET FAMILY WELLNESS CENTER
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Dates
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Enumeration Date | 11/20/2012
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Last Update Date | 11/20/2012
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Provider Practice Location Address
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Address Line | 210 US HIGHWAY 89
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City | BROWNING
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State | MT
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Zip | 59417-9721
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Country | US
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Telephone | 406-338-5180
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Fax | 406-338-5660
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Provider Business Mailing Address
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Address Line | 210 US HIGHWAY 89
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City | BROWNING
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State | MT
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Zip | 59417-9721
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Country | US
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Telephone | 406-338-5180
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Fax | 406-338-5660
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. CRYSTAL R EVANS
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Credential | PHD
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Telephone | 406-338-5180
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 12946
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License Number State | MT
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 12946
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License Number State | MT
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