Provider Demographics
NPI:1407215577
Name:TALLWHITEMAN, FAITH ANN (BBH-LAC-LIC-30311)
Entity Type:Individual
Prefix:MS
First Name:FAITH
Middle Name:ANN
Last Name:TALLWHITEMAN
Suffix:
Gender:F
Credentials:BBH-LAC-LIC-30311
Other - Prefix:MISS
Other - First Name:FAITH
Other - Middle Name:ANN
Other - Last Name:PAYNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2221 GOLDEN BLVD
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-1245
Mailing Address - Country:US
Mailing Address - Phone:406-670-3002
Mailing Address - Fax:
Practice Address - Street 1:1320 N 30TH ST.
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101
Practice Address - Country:US
Practice Address - Phone:406-534-4558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-18
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-ACLC-LIC-13362101YA0400X
MTBBH-SWLC-LIC-323051041C0700X
MTBBH-LAC-LIC-30311101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1407215577Medicaid