Provider Demographics
NPI:1992868244
Name:ROSSTON, KARL FREDERICK (LCSW)
Entity Type:Individual
Prefix:MR
First Name:KARL
Middle Name:FREDERICK
Last Name:ROSSTON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 SHINGLE BUTTE RD
Mailing Address - Street 2:
Mailing Address - City:MONTANA CITY
Mailing Address - State:MT
Mailing Address - Zip Code:59634-9667
Mailing Address - Country:US
Mailing Address - Phone:406-449-4623
Mailing Address - Fax:406-449-2196
Practice Address - Street 1:1125 MISSOULA AVE
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-3801
Practice Address - Country:US
Practice Address - Phone:406-449-4623
Practice Address - Fax:406-449-2196
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT578-LCSW1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical