Provider Demographics
NPI:1740437516
Name:STENEHJEM, GERALD ALLEN (LCSW)
Entity type:Individual
Prefix:
First Name:GERALD
Middle Name:ALLEN
Last Name:STENEHJEM
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:PO BOX 1266
Mailing Address - Street 2:NORTHWEST HUMAN SERVICES CENTER
Mailing Address - City:WILLISTON
Mailing Address - State:ND
Mailing Address - Zip Code:58802-1266
Mailing Address - Country:US
Mailing Address - Phone:701-774-4600
Mailing Address - Fax:701-774-4620
Practice Address - Street 1:316 2ND AVE W
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:ND
Practice Address - Zip Code:58801-5218
Practice Address - Country:US
Practice Address - Phone:701-774-4600
Practice Address - Fax:701-774-4620
Is Sole Proprietor?:No
Enumeration Date:2008-08-25
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT848 LCSW101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0000070836OtherBLUE CROSS-SHIELD OF MONTANA PROVIDER #
MTP00718779 C01340OtherRAILROAD MEDICARE
MTP00718779 C01340OtherRAILROAD MEDICARE