Provider Demographics
NPI:1033793419
Name:ALLEN, VALERIE JANE (LACC)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:JANE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:LACC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 TWO MILE BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:ROBERTS
Mailing Address - State:MT
Mailing Address - Zip Code:59070-9410
Mailing Address - Country:US
Mailing Address - Phone:406-850-0081
Mailing Address - Fax:
Practice Address - Street 1:111 N BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:RED LODGE
Practice Address - State:MT
Practice Address - Zip Code:59068-9031
Practice Address - Country:US
Practice Address - Phone:406-446-0337
Practice Address - Fax:406-646-3020
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-11
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT41855101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty