Provider Demographics
NPI:1104287267
Name:WINTERS, SHAWN LEE
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:LEE
Last Name:WINTERS
Suffix:
Gender:M
Credentials:
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 3089
Mailing Address - Street 2:CENTER FOR MENTAL HEALTH
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59403-3089
Mailing Address - Country:US
Mailing Address - Phone:406-727-4315
Mailing Address - Fax:406-791-9629
Practice Address - Street 1:513 1ST AVE S
Practice Address - Street 2:CENTER FOR MENTAL HEALTH/PACT
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59401-3604
Practice Address - Country:US
Practice Address - Phone:406-727-4315
Practice Address - Fax:406-791-9629
Is Sole Proprietor?:No
Enumeration Date:2016-03-16
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT164521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTOMT0703543OtherBLUE CROSS-SHIELD OF MONTANA
MTOMT0703543OtherBLUE CROSS-SHIELD OF MONTANA