Provider Demographics
NPI:1194840900
Name:STROM, PETER (MS LCPC)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:
Last Name:STROM
Suffix:
Gender:M
Credentials:MS LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 SOUTHVIEW RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-7800
Mailing Address - Country:US
Mailing Address - Phone:406-582-7973
Mailing Address - Fax:406-582-7973
Practice Address - Street 1:612 E MAIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-3719
Practice Address - Country:US
Practice Address - Phone:406-580-3228
Practice Address - Fax:406-582-7973
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1207101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT743330OtherBLUE CROSS BLUE SHIELD MT