Active NPI
Jen Acacia Mittelstadt, MSW
- Clinical Social Worker
- Helena, MT
National Provider Identifier
1558032698
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- BBH-SWLC-LIC-50526
- Practice address
- 54 N Last Chance Gulch Ste 213
Helena, MT 59601-4179 - Phone
- (406) 439-2031
- NPI assigned
- Sep 27, 2021
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | BBH-SWLC-LIC-50526 | MT | Primary |
Addresses
Primary practice location
54 N Last Chance Gulch Ste 213
Helena, MT 59601-4179
Mailing address
PO Box 272
Helena, MT 59624-0272
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250110000753 | MT | Practitioner - Clinical Social Worker | 0840728465 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| BBH-SWLC-LIC-50526 | MT | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lupine Mental Health and Wellness | Clinical | Current | Accepting new patients |
Locations
32 S Ewing St
Ste 318
Helena, MT 59601
Phone (406) 285-8929
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": "1632700800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1632700800000",
"number": "1558032698",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 272",
"city": "HELENA",
"state": "MT",
"postal_code": "596240272"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "54 N LAST CHANCE GULCH STE 213",
"city": "HELENA",
"state": "MT",
"postal_code": "596014179",
"telephone_number": "406-439-2031"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MITTELSTADT",
"first_name": "JEN",
"middle_name": "ACACIA",
"credential": "MSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-09-27",
"last_updated": "2021-09-27",
"certification_date": "2021-09-21",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MT",
"license": "BBH-SWLC-LIC-50526",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Helena, MT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.