Provider Demographics
NPI:1972650505
Name:KEEFER, AMY LICHTENSTEIN (LCSW)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:LICHTENSTEIN
Last Name:KEEFER
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 1:1202 S PINECREST DR
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-5943
Mailing Address - Country:US
Mailing Address - Phone:406-581-9855
Mailing Address - Fax:406-587-9422
Practice Address - Street 1:2050 FAIRWAY DR
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-5871
Practice Address - Country:US
Practice Address - Phone:406-581-9855
Practice Address - Fax:406-587-9422
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTLCSW-5091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0503625Medicaid