1174869663 NPI number — BARBARA ANN NELSON LCPC

Table of content: BARBARA ANN NELSON LCPC (NPI 1174869663)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174869663 NPI number — BARBARA ANN NELSON LCPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NELSON
Provider First Name:
BARBARA
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CROXFORD
Provider Other First Name:
BARBARA
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCPC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1174869663
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/29/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3089
Provider Second Line Business Mailing Address:
CENTER FOR MENTAL HEALTH
Provider Business Mailing Address City Name:
GREAT FALLS
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59403-3089
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-761-2100
Provider Business Mailing Address Fax Number:
406-761-2107

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1800 19TH AVE S
Provider Second Line Business Practice Location Address:
CENTER FOR MENTAL HEALTH/SUNNYSIDE ELEMENTARY
Provider Business Practice Location Address City Name:
GREAT FALLS
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59405-6130
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-761-2100
Provider Business Practice Location Address Fax Number:
406-761-2107
Provider Enumeration Date:
01/02/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  4230 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0000748110 . This is a "BLUE CROSS-SHIELD OF MONTANA" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".




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