Provider Demographics
NPI:1194808949
Name:HURD, CAMILLA O (LCSW)
Entity type:Individual
Prefix:MS
First Name:CAMILLA
Middle Name:O
Last Name:HURD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:CAMILLA
Other - Middle Name:O
Other - Last Name:BERGSTROM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:533 EVANS RICEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BELT
Mailing Address - State:MT
Mailing Address - Zip Code:59412-8400
Mailing Address - Country:US
Mailing Address - Phone:406-736-5613
Mailing Address - Fax:406-736-5321
Practice Address - Street 1:208 N 29TH ST
Practice Address - Street 2:SUITES 236-237
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-1985
Practice Address - Country:US
Practice Address - Phone:406-899-1008
Practice Address - Fax:406-736-5321
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTMT3271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT050-3308Medicaid
MT050-3308Medicaid