Provider Demographics
NPI:1871656827
Name:STIVERS, COLEEN MAE (LCSW)
Entity Type:Individual
Prefix:
First Name:COLEEN
Middle Name:MAE
Last Name:STIVERS
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:PO BOX 3089
Mailing Address - Street 2:CENTER FOR MENTAL HEALTH
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59403-3089
Mailing Address - Country:US
Mailing Address - Phone:406-761-2100
Mailing Address - Fax:406-761-2107
Practice Address - Street 1:915 1ST AVE S
Practice Address - Street 2:CENTER FOR MENTAL HEALTH
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59401-3705
Practice Address - Country:US
Practice Address - Phone:406-761-2100
Practice Address - Fax:406-761-2107
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT2251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0000701423OtherBLUE CROSS-SHIELD OF MONTANA
MTP01365201OtherRAILROAD MEDICARE
MT0000701423OtherBLUE CROSS-SHIELD OF MONTANA