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General NPI Number Information
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NPI Number | 1578066544
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Entity Type | Individual
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Provider Name | KERI STEPHANOFF LCSW, LCPC, LBA
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Gender | Female
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Dates
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Enumeration Date | 03/15/2018
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Last Update Date | 02/03/2022
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Provider Practice Location Address
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Address Line | 5915 ALBANY AVE
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City | BUTTE
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State | MT
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Zip | 59701-7402
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Country | US
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Telephone | 406-221-6273
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Fax |
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Provider Business Mailing Address
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Address Line | 116082 FLEECER RD
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City | BUTTE
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State | MT
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Zip | 59750-9710
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Country | US
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Telephone | 406-221-6273
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | BBH-LCPC-LIC-34703
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License Number State | MT
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-21-48155
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License Number State | MT
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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 | BBH-LCSW-LIC-38882
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License Number State | MT
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