Provider Demographics
NPI:1760842405
Name:GYFORD, KRISTIN JEAN (LCSW)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:JEAN
Last Name:GYFORD
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 1:2746 WHITES LN
Mailing Address - Street 2:
Mailing Address - City:VICTOR
Mailing Address - State:MT
Mailing Address - Zip Code:59875-9545
Mailing Address - Country:US
Mailing Address - Phone:406-219-5002
Mailing Address - Fax:541-610-1887
Practice Address - Street 1:4037 US HWY 93N, STEVENSVILLE, MT 59870
Practice Address - Street 2:UNIT C
Practice Address - City:STEVENSVILLE
Practice Address - State:MT
Practice Address - Zip Code:59870-6473
Practice Address - Country:US
Practice Address - Phone:406-219-5002
Practice Address - Fax:877-940-3555
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-23
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LCSW-LIC-558931041C0700X, 1041C0700X
ORL79761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical