Provider Demographics
NPI:1821515925
Name:MORTENSEN-BLACKWOOD, SHERI LEE (LCPC)
Entity Type:Individual
Prefix:
First Name:SHERI LEE
Middle Name:
Last Name:MORTENSEN-BLACKWOOD
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:SHERI
Other - Middle Name:
Other - Last Name:BLACKWOOD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCPC
Mailing Address - Street 1:2505 FAIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-5862
Mailing Address - Country:US
Mailing Address - Phone:406-579-1531
Mailing Address - Fax:
Practice Address - Street 1:2505 FAIRWAY DRIVE
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715
Practice Address - Country:US
Practice Address - Phone:406-579-1531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT73489101YS0200X
MTBBH-LCPC-LIC-1332101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool