Provider Demographics
NPI:1679450027
Name:STAGG, EVYNN ELIZABETH
Entity type:Individual
Prefix:
First Name:EVYNN
Middle Name:ELIZABETH
Last Name:STAGG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:618 SPRINGHILL LN
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-9321
Mailing Address - Country:US
Mailing Address - Phone:406-599-7042
Mailing Address - Fax:
Practice Address - Street 1:3731 EQUESTRIAN LN STE 105
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-5660
Practice Address - Country:US
Practice Address - Phone:406-599-7042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-18
Last Update Date:2025-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-PCLC-LIC-81077101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health