Provider Demographics
NPI:1306453584
Name:JOHN SHEEHAN LCSW LLC
Entity type:Organization
Organization Name:JOHN SHEEHAN LCSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:SHEEHAN
Authorized Official - Suffix:III
Authorized Official - Credentials:LCSW
Authorized Official - Phone:406-396-5179
Mailing Address - Street 1:PO BOX 5631
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59806-5631
Mailing Address - Country:US
Mailing Address - Phone:406-396-5179
Mailing Address - Fax:
Practice Address - Street 1:520 S 3RD ST W
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-2518
Practice Address - Country:US
Practice Address - Phone:406-209-8826
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-30
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty