Provider Demographics
NPI:1386619260
Name:CARLSON-THOMPSON, DANIEL K (LCSW)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:K
Last Name:CARLSON-THOMPSON
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 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:406-443-7151
Mailing Address - Fax:406-443-3420
Practice Address - Street 1:900 N JACKSON ST
Practice Address - Street 2:CENTER FOR MENTAL HEALTH
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-3428
Practice Address - Country:US
Practice Address - Phone:406-443-7151
Practice Address - Fax:406-443-3420
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2009-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT306 LCSW1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0000070703OtherBLUE CROSS/SHIELD OF MONT
MTP00692014 C01340OtherRAILROAD MEDICARE
MTP00692014 C01340OtherRAILROAD MEDICARE