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General NPI Number Information
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NPI Number | 1568716090
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Entity Type | Organization
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Legal Business Name | NORTHERN CHEYENNE TRIBE
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Dates
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Enumeration Date | 11/06/2012
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Last Update Date | 04/26/2024
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Provider Practice Location Address
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Address Line | 420 NORTH CHEYENNE AVENUE LAME DEER HEALTH CENTER - BEHAVIOR HEALTH
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City | LAME DEER
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State | MT
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Zip | 59043
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Country | US
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Telephone | 406-477-4514
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Fax | 406-477-4513
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Provider Business Mailing Address
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Address Line | PO BOX 128 600 CHEYENNE AVE SOUTH
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City | LAME DEER
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State | MT
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Zip | 59043-0128
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Country | US
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Telephone | 406-477-6722
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Fax | 406-477-8621
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Authorized Official
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Title or Position | DIRECTOR OF REVENUE ENHANCEMENT
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Name | MARIA ROUNDSTONE
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Credential |
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Telephone | 406-477-6722
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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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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Taxonomy #4
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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