Provider Demographics
NPI:1184183600
Name:ANNIE BERNAUER LCSW LLC
Entity Type:Organization
Organization Name:ANNIE BERNAUER LCSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BERNAUER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:406-552-8892
Mailing Address - Street 1:PO BOX 614
Mailing Address - Street 2:
Mailing Address - City:VICTOR
Mailing Address - State:MT
Mailing Address - Zip Code:59875-0614
Mailing Address - Country:US
Mailing Address - Phone:406-552-8892
Mailing Address - Fax:
Practice Address - Street 1:2489 CHIEF VICTOR CAMP RD
Practice Address - Street 2:
Practice Address - City:VICTOR
Practice Address - State:MT
Practice Address - Zip Code:59875-9410
Practice Address - Country:US
Practice Address - Phone:406-552-8892
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-14
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty