Amanda Jane Fahlstrom, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

37551 Issued in MT

Practice address

145 Mill Town Loop Ste B
Bozeman, MT 59718-5144

Phone

(406) 219-1350

Fax

(406) 219-0749

NPI assigned

Jun 13, 2019

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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

Specialty

Clinical Social Worker

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Family Counseling Center of Mt

  • Community/Behavioral Health Agency
  • Bozeman, MT
  • NPI 1811572647

  MT, Single Specialty

  Medicare reassignment NPD Authorized official
• Western Montana Mental Health Center

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Missoula, MT
  • NPI 1912079328

  Clinical

  NPD (past)

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

{
    "created_epoch": "1560384000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633478400000",
    "number": "1962061887",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7003",
            "city": "BOZEMAN",
            "state": "MT",
            "postal_code": "597717003",
            "telephone_number": "406-219-1350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "145 MILL TOWN LOOP STE B",
            "city": "BOZEMAN",
            "state": "MT",
            "postal_code": "597185144",
            "telephone_number": "406-219-1350",
            "fax_number": "406-219-0749"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAHLSTROM",
        "first_name": "AMANDA",
        "middle_name": "JANE",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-06-13",
        "last_updated": "2021-10-06",
        "certification_date": "2021-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "MT",
            "license": "37551",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Explore Counseling, PLLC
• Eyes on Main Incorporated
• Laken Eylander
• George Faegre
• Nicole Marie Faessel, APRN
• James Franklin Fair III, M.D.
• Tracy Marie Fairbanks, MD
• Kendra Fajardo, AU.D.
• Family Counseling Center of Mt
• Family Doctors Urgent Care LLC

• Clinical Social Worker in Bozeman, MT
• Providers in Bozeman, MT by specialty
• Clinical Social Worker in Montana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.