Provider Demographics
NPI:1518596006
Name:STOKES, HEATHER KIM (LCSW)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:KIM
Last Name:STOKES
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 1:6309 HILLVIEW WAY
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59803-3374
Mailing Address - Country:US
Mailing Address - Phone:917-553-0602
Mailing Address - Fax:
Practice Address - Street 1:6309 HILLVIEW WAY
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59803-3374
Practice Address - Country:US
Practice Address - Phone:917-553-0602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-06
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0524041041C0700X
MTBBH-LCSW-LIC-314691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical