Provider Demographics
NPI:1306393194
Name:DANA EISENBERG, LCSW COUNSELING AND CONSULTATION, LLC
Entity Type:Organization
Organization Name:DANA EISENBERG, LCSW COUNSELING AND CONSULTATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANA
Authorized Official - Middle Name:
Authorized Official - Last Name:EISENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:406-239-1106
Mailing Address - Street 1:528 CLEVELAND ST
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-3743
Mailing Address - Country:US
Mailing Address - Phone:406-239-1106
Mailing Address - Fax:
Practice Address - Street 1:528 CLEVELAND ST
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-3743
Practice Address - Country:US
Practice Address - Phone:406-239-1106
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-08
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTLCSW 580251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health