Provider Demographics
NPI:1740350461
Name:SMITH, NANCY M (MSW, LCSW, LAC)
Entity type:Individual
Prefix:MS
First Name:NANCY
Middle Name:M
Last Name:SMITH
Suffix:
Gender:F
Credentials:MSW, LCSW, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89 MILL CREEK RD
Mailing Address - Street 2:
Mailing Address - City:SAINT REGIS
Mailing Address - State:MT
Mailing Address - Zip Code:59866-9710
Mailing Address - Country:US
Mailing Address - Phone:406-649-2761
Mailing Address - Fax:406-822-5423
Practice Address - Street 1:304 4TH AVE E
Practice Address - Street 2:
Practice Address - City:SUPERIOR
Practice Address - State:MT
Practice Address - Zip Code:59872-3075
Practice Address - Country:US
Practice Address - Phone:406-822-5422
Practice Address - Fax:406-324-7062
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT6351041C0700X
MT765101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT780552000OtherMAGELLAN
MT0503183Medicaid
MT70675OtherBLUE CROSS BLUE SHIELD
MT5588OtherMONTANA STATE LICENSE
MT0503183Medicaid