MEDICARE: SAMUEL HARKNESS MSW, SWLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	BBH-SWLM-LIC-64449	MT

General Provider Information

NPI Number	:	1992581284
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMUEL HARKNESS MSW, SWLC

Provider Business Mailing Address
First Line	:	1675 2ND ST E
Second Line	:
City	:	WHITEFISH
State	:	MT
Zip	:	59937-8149
Country	:	US
Telephone Number	:	406-260-3279
Fax Number	:	406-260-3279

Provider Business Practice Location Address
First Line	:	144 2ND ST E STE 202
Second Line	:
City	:	WHITEFISH
State	:	MT
Zip	:	59937-2402
Country	:	US
Telephone Number	:	406-260-3279
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/04/2023
Last Update Date	:	09/04/2023

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