Provider Demographics
NPI:1518201102
Name:BLACKFEET FAMILY WELLNESS CENTER
Entity Type:Organization
Organization Name:BLACKFEET FAMILY WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:R
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:406-338-5180
Mailing Address - Street 1:210 US HIGHWAY 89
Mailing Address - Street 2:
Mailing Address - City:BROWNING
Mailing Address - State:MT
Mailing Address - Zip Code:59417-9721
Mailing Address - Country:US
Mailing Address - Phone:406-338-5180
Mailing Address - Fax:406-338-5660
Practice Address - Street 1:210 US HIGHWAY 89
Practice Address - Street 2:
Practice Address - City:BROWNING
Practice Address - State:MT
Practice Address - Zip Code:59417-9721
Practice Address - Country:US
Practice Address - Phone:406-338-5180
Practice Address - Fax:406-338-5660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-20
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT12946251B00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management