1881608578 NPI number — DR. SUE ANNE TANNER WORKMAN POLLINGTON PHD, LCSW, LAC

Table of content: DR. SUE ANNE TANNER WORKMAN POLLINGTON PHD, LCSW, LAC (NPI 1881608578)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881608578 NPI number — DR. SUE ANNE TANNER WORKMAN POLLINGTON PHD, LCSW, LAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WORKMAN POLLINGTON
Provider First Name:
SUE ANNE
Provider Middle Name:
TANNER
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD, LCSW, LAC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WORKMAN
Provider Other First Name:
SUE
Provider Other Middle Name:
ANNE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHD. LCSW, LAC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1881608578
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/11/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1023 5TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAVRE
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59501-4106
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-217-5222
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1023 5TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAVRE
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59501-4106
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-217-5222
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/28/2006

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: 1041C0700X , with the licence number:  352 LCSW , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YA0400X , with the licence number: 1253 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 01752-C . This is a "NEVADA LCSW LICENSE" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".
  • Identifier: 000070165 . This is a "BLUE CROSS/SHIELD OF MONT" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".
  • Identifier: 1253 LAC . This is a "LAC" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".
  • Identifier: 352 LCSW . This is a "LCSW" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".
  • Identifier: 16797 . This is a "CALIFORNIA LCSW LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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