Provider Demographics
NPI:1821440223
Name:SIEBENALLER, BLYTHE (LCSW, LAC)
Entity Type:Individual
Prefix:
First Name:BLYTHE
Middle Name:
Last Name:SIEBENALLER
Suffix:
Gender:F
Credentials:LCSW, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:714 STONERIDGE DR STE 1
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-7046
Mailing Address - Country:US
Mailing Address - Phone:406-418-5400
Mailing Address - Fax:
Practice Address - Street 1:714 STONERIDGE DR STE 1
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-7046
Practice Address - Country:US
Practice Address - Phone:406-418-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-08
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LAC-LIC-16193101YA0400X
MTBBH-LCSW-LIC-504811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)