=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962086454
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KATHERINE BOYD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/11/2021
-----------------------------------------------------
Last Update Date | 05/11/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 633 COLORADO AVE
-----------------------------------------------------
City | WHITEFISH
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59937-3408
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-249-8694
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 633 COLORADO AVE
-----------------------------------------------------
City | WHITEFISH
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59937-3408
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-249-8694
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | BBH-LCSW-LIC-38995
-----------------------------------------------------
License Number State | MT
-----------------------------------------------------