=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538527353
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUNBURST COUNSELING SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/08/2016
-----------------------------------------------------
Last Update Date | 02/08/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2200 BOX ELDER ST
-----------------------------------------------------
City | MILES CITY
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59301-2899
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 432-270-1276
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 714
-----------------------------------------------------
City | MILES CITY
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59301-0714
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | SHAD BARROWS
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 432-270-1276
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | SWP-LCSW-LIC-8009
-----------------------------------------------------
License Number State | MT
-----------------------------------------------------