Provider Demographics
NPI:1447316989
Name:DENNIS, GLORIA RETA (LCSW)
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:RETA
Last Name:DENNIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8782 SYPES CANYON RD
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-8453
Mailing Address - Country:US
Mailing Address - Phone:406-522-8656
Mailing Address - Fax:
Practice Address - Street 1:2020 CHARLOTTE ST
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-2774
Practice Address - Country:US
Practice Address - Phone:406-522-7682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT5341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT71363OtherBLUECROSS BLUESHIELD
MT71363OtherBLUECROSS BLUESHIELD