Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | 1358-LCPC | MT |
N | 104100000X | Social Worker |
NPI | 1003065459 |
---|---|
Provider Name | Ms. Sue Ellen Silverberg |
First Address | Missoula, MT 59801-1309 |
Second Address | Missoula, MT 59801-1309 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/09/2008 |
Last Update Date | 30/06/2015 |