Individual provider Active NPI

Craig Lyle Stevenson, LCSW

  • Clinical Social Worker
  • Polson, MT
National Provider Identifier
1285266221
Registry record updated Jul 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
BBH-LCSW-42585 Issued in MT
Practice address
2 6TH Ave E
Polson, MT 59860-2726
Phone
(406) 439-7401
NPI assigned
Feb 7, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 18, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X BBH-LCSW-42585
Clinical Social Worker 1041C0700X 42585 MT
Clinical Social Worker 1041C0700X BBH-LCSW-42585 MT Primary

Addresses

Primary practice location

2 6TH Ave E
Polson, MT 59860-2726

Mailing address

PO Box 1365
Polson, MT 59860-1365
Phone (406) 439-7401

Other practice location 1

106 Ridgewater Dr
Polson, MT 59860-8977
Phone (406) 883-3200

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address Krmcmedicalrecords@krhdirect.org Direct Kalispell Regional Medical Center, Inc

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MT
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20251231003791 MT Practitioner - Clinical Social Worker 5991236085 Practice locations: Polson, MT

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

314 1St St W
Suite 200
Polson, MT 59860-1365
Phone (406) 282-3222

PO Box
Suite 1365
Polson, MT 59860

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
42585MTMDClinical Social Worker
BBH-LCSW-42585MTMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Mind Flow Therapeutics LLC Clinical CurrentSince Jun 14, 2020 Accepting new patients

Locations

2 6th Ave E
Polson, MT 59860
Phone (406) 214-3137

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1581033600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721260800000",
    "number": "1285266221",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1365",
            "city": "POLSON",
            "state": "MT",
            "postal_code": "598601365",
            "telephone_number": "406-439-7401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 6TH AVE E",
            "city": "POLSON",
            "state": "MT",
            "postal_code": "598602726",
            "telephone_number": "406-439-7401"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "106 Ridgewater Dr",
            "address_purpose": "LOCATION",
            "city": "Polson",
            "state": "MT",
            "postal_code": "598608977",
            "country_code": "US",
            "telephone_number": "406-883-3200",
            "fax_number": "406-883-9483",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "STEVENSON",
        "first_name": "CRAIG",
        "middle_name": "LYLE",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-02-07",
        "last_updated": "2024-07-18",
        "certification_date": "2024-07-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": "BBH-LCSW-42585",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MT",
            "license": "42585",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MT",
            "license": "BBH-LCSW-42585",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Krmcmedicalrecords@krhdirect.org",
            "affiliation": "Y",
            "affiliationName": "Kalispell Regional Medical Center, Inc",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "106 Ridgewater Dr",
            "city": "Polson",
            "state": "MT",
            "country_code": "US",
            "postal_code": "598608977",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Polson, MT

Sources for this page

Verify at the official NPI Registry.