Provider Demographics
NPI:1578176079
Name:NORTH SHORE THERAPY LLC
Entity Type:Organization
Organization Name:NORTH SHORE THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW
Authorized Official - Prefix:
Authorized Official - First Name:MALIA
Authorized Official - Middle Name:B
Authorized Official - Last Name:HALSTVEDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-272-2440
Mailing Address - Street 1:1220 AVENUE C APT F
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-3200
Mailing Address - Country:US
Mailing Address - Phone:406-272-2440
Mailing Address - Fax:
Practice Address - Street 1:1220 AVENUE C APT F
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-3200
Practice Address - Country:US
Practice Address - Phone:406-272-2440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-25
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty