Provider Demographics
NPI:1245653187
Name:DORWART, CONNIE JO I
Entity type:Individual
Prefix:MRS
First Name:CONNIE
Middle Name:JO
Last Name:DORWART
Suffix:I
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:CONNIE
Other - Middle Name:JO
Other - Last Name:DORWART
Other - Suffix:I
Other - Last Name Type:Professional Name
Other - Credentials:LCPC
Mailing Address - Street 1:PO BOX 37
Mailing Address - Street 2:
Mailing Address - City:FORT PECK
Mailing Address - State:MT
Mailing Address - Zip Code:59223-0037
Mailing Address - Country:US
Mailing Address - Phone:406-695-2241
Mailing Address - Fax:406-695-2243
Practice Address - Street 1:55 BASIN CREEK RD
Practice Address - Street 2:
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-9704
Practice Address - Country:US
Practice Address - Phone:406-496-6314
Practice Address - Fax:406-494-1724
Is Sole Proprietor?:No
Enumeration Date:2014-01-29
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT101YM0800X101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health