Provider Demographics
NPI:1326673617
Name:SPOT TO TALK, A LICENSED CLINICAL SOCIAL WORKER CORPORATION
Entity Type:Organization
Organization Name:SPOT TO TALK, A LICENSED CLINICAL SOCIAL WORKER CORPORATION
Other - Org Name:SPOT TO TALK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CLAIRE
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:WICK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:406-201-9711
Mailing Address - Street 1:191 JEWEL BASIN CT STE 3D
Mailing Address - Street 2:
Mailing Address - City:BIGFORK
Mailing Address - State:MT
Mailing Address - Zip Code:59911-6294
Mailing Address - Country:US
Mailing Address - Phone:406-201-9711
Mailing Address - Fax:
Practice Address - Street 1:191 JEWEL BASIN CT STE 3D
Practice Address - Street 2:
Practice Address - City:BIGFORK
Practice Address - State:MT
Practice Address - Zip Code:59911-6294
Practice Address - Country:US
Practice Address - Phone:406-201-9711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-06
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health