Provider Demographics
NPI:1225043102
Name:DAVID C SEGERSTROM PC
Entity Type:Organization
Organization Name:DAVID C SEGERSTROM PC
Other - Org Name:MONTANA BEHAVIORAL HEALTH NW
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:SEGERSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:406-755-7566
Mailing Address - Street 1:38 VILLAGE LOOP RD
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-2793
Mailing Address - Country:US
Mailing Address - Phone:406-755-7566
Mailing Address - Fax:406-755-7599
Practice Address - Street 1:38 VILLAGE LOOP RD
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-2793
Practice Address - Country:US
Practice Address - Phone:406-755-7566
Practice Address - Fax:406-755-7599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT2201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty