=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780355529
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HEATHER MICHELLE NITZ LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/22/2021
-----------------------------------------------------
Last Update Date | 09/22/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 704 N 30TH ST
-----------------------------------------------------
City | BILLINGS
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59101-0913
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-259-8800
-----------------------------------------------------
Fax | 406-259-4400
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 704 N 30TH ST
-----------------------------------------------------
City | BILLINGS
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59101-0913
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-259-8800
-----------------------------------------------------
Fax | 406-259-4400
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | BBH-LCSW-LIC-8310
-----------------------------------------------------
License Number State | MT
-----------------------------------------------------