Provider Demographics
NPI:1679195242
Name:SAPPHIRE BEHAVIORAL HEALTH LLC
Entity Type:Organization
Organization Name:SAPPHIRE BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAREISSA-MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SWENSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:406-980-1741
Mailing Address - Street 1:502 N PINE ST
Mailing Address - Street 2:
Mailing Address - City:TOWNSEND
Mailing Address - State:MT
Mailing Address - Zip Code:59644-2008
Mailing Address - Country:US
Mailing Address - Phone:406-980-1741
Mailing Address - Fax:
Practice Address - Street 1:502 N PINE ST
Practice Address - Street 2:
Practice Address - City:TOWNSEND
Practice Address - State:MT
Practice Address - Zip Code:59644-2008
Practice Address - Country:US
Practice Address - Phone:406-980-1741
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-17
Last Update Date:2020-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health