1376564575 NPI number — CHARLENE KAY SCHMITZ LCSW

Table of content: CHARLENE KAY SCHMITZ LCSW (NPI 1376564575)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376564575 NPI number — CHARLENE KAY SCHMITZ LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHMITZ
Provider First Name:
CHARLENE
Provider Middle Name:
KAY
Provider Name Prefix Text:
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:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376564575
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/02/2009
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:
406-265-9639
Provider Business Mailing Address Fax Number:
406-265-6771

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
312 3RD ST
Provider Second Line Business Practice Location Address:
CENTER FOR MENTAL HEALTH
Provider Business Practice Location Address City Name:
HAVRE
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59501-3534
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-265-9639
Provider Business Practice Location Address Fax Number:
406-265-6771
Provider Enumeration Date:
07/22/2006

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:  590 LCSW , 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: P00692066 C01340 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".
  • Identifier: 0000071493 . This is a "BLUE CROSS/SHIELD OF MONT" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".