Provider Demographics
NPI:1073079364
Name:SIMPSON, WENDY R (LCSW, LAC)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:R
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:LCSW, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 E BROADWAY ST # 10
Mailing Address - Street 2:
Mailing Address - City:BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59701-9305
Mailing Address - Country:US
Mailing Address - Phone:406-624-9744
Mailing Address - Fax:
Practice Address - Street 1:65 E BROADWAY ST
Practice Address - Street 2:
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-9305
Practice Address - Country:US
Practice Address - Phone:406-624-9744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-12
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LAC-LIC-37005101YA0400X
MTBBH-LCSW-LIC-711981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTBBH-LAC-LIC-37005OtherLICENSE
MTBBH-SWLC-LIC-35048OtherLICENSE