Provider Demographics
NPI:1316900368
Name:ABBOTT, SHAWN LYNN (LCSW)
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:LYNN
Last Name:ABBOTT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 CENTRAL AVE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59401-3179
Mailing Address - Country:US
Mailing Address - Phone:406-761-1700
Mailing Address - Fax:406-761-1780
Practice Address - Street 1:600 CENTRAL AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59401-3179
Practice Address - Country:US
Practice Address - Phone:406-761-1700
Practice Address - Fax:406-761-1780
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-10
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT479-LCSW1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT75218OtherBLUE CROSS BLUE SHIELD
MT0000500242Medicaid
MT000050022Medicare ID - Type Unspecified