Provider Demographics
NPI:1386524304
Name:SUNDSTROM, ELIJAH LOGAN (ACLC)
Entity type:Individual
Prefix:
First Name:ELIJAH
Middle Name:LOGAN
Last Name:SUNDSTROM
Suffix:
Gender:M
Credentials:ACLC
Other - Prefix:
Other - First Name:ECHO
Other - Middle Name:
Other - Last Name:SUNDSTROM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ACLC
Mailing Address - Street 1:601 1ST AVE N
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59401-2510
Mailing Address - Country:US
Mailing Address - Phone:406-454-6973
Mailing Address - Fax:406-791-9277
Practice Address - Street 1:510 1ST AVE N
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59401-2592
Practice Address - Country:US
Practice Address - Phone:406-454-6973
Practice Address - Fax:406-791-9277
Is Sole Proprietor?:No
Enumeration Date:2025-09-03
Last Update Date:2025-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-ACLC-LIC-81309101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)