Provider Demographics
NPI:1518368406
Name:REILLY, AMBER L (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:L
Last Name:REILLY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 BAKER ST
Mailing Address - Street 2:
Mailing Address - City:BELGRADE
Mailing Address - State:MT
Mailing Address - Zip Code:59714-9170
Mailing Address - Country:US
Mailing Address - Phone:406-204-4577
Mailing Address - Fax:
Practice Address - Street 1:333 HAGGERTY LN STE 2
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-1780
Practice Address - Country:US
Practice Address - Phone:406-580-3027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-10
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LCSW-LIC-84741041C0700X
MTSWP-LCSW-LIC-84741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical