1194808949 NPI number — MS. CAMILLA O HURD LCSW

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194808949 NPI number — MS. CAMILLA O HURD LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HURD
Provider First Name:
CAMILLA
Provider Middle Name:
O
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BERGSTROM
Provider Other First Name:
CAMILLA
Provider Other Middle Name:
O.
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1194808949
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
533 EVANS RICEVILLE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELT
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59412-8400
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-736-5613
Provider Business Mailing Address Fax Number:
406-736-5321

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
208 N 29TH ST
Provider Second Line Business Practice Location Address:
SUITES 236-237
Provider Business Practice Location Address City Name:
BILLINGS
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59101-1985
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-899-1008
Provider Business Practice Location Address Fax Number:
406-736-5321
Provider Enumeration Date:
10/23/2006

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:  MT327 , 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: 050-3308 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".




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