Provider Demographics
NPI:1285266221
Name:STEVENSON, CRAIG LYLE (LCSW)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:LYLE
Last Name:STEVENSON
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 1365
Mailing Address - Street 2:
Mailing Address - City:POLSON
Mailing Address - State:MT
Mailing Address - Zip Code:59860-1365
Mailing Address - Country:US
Mailing Address - Phone:406-439-7401
Mailing Address - Fax:
Practice Address - Street 1:2 6TH AVE E
Practice Address - Street 2:
Practice Address - City:POLSON
Practice Address - State:MT
Practice Address - Zip Code:59860-2726
Practice Address - Country:US
Practice Address - Phone:406-439-7401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-07
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
BBH-LCSW-425851041C0700X
MT425851041C0700X
MTBBH-LCSW-425851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical