Provider Demographics
NPI:1053388850
Name:TOBIN, STEPHEN M (LCSW, LAC)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:M
Last Name:TOBIN
Suffix:
Gender:M
Credentials:LCSW, LAC
Other - Prefix:
Other - First Name:STEVE
Other - Middle Name:
Other - Last Name:TOBIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW, LAC
Mailing Address - Street 1:303 N BROADWAY
Mailing Address - Street 2:SUITE 603
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59101-1255
Mailing Address - Country:US
Mailing Address - Phone:406-255-8679
Mailing Address - Fax:406-259-5618
Practice Address - Street 1:303 N BROADWAY
Practice Address - Street 2:SUITE 603
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-1255
Practice Address - Country:US
Practice Address - Phone:406-255-8679
Practice Address - Fax:406-259-5618
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-01
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT698101YA0400X
MT971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0500225Medicaid
MTM000050015Medicare PIN