Provider Demographics
NPI:1043514599
Name:MESSERLY, JULIE LORETTA (LAC)
Entity Type:Individual
Prefix:MS
First Name:JULIE
Middle Name:LORETTA
Last Name:MESSERLY
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 2ND AVE N
Mailing Address - Street 2:SUITE #7
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59401-2666
Mailing Address - Country:US
Mailing Address - Phone:406-868-7832
Mailing Address - Fax:
Practice Address - Street 1:1125 2ND AVE N
Practice Address - Street 2:SUITE #7
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59401-2666
Practice Address - Country:US
Practice Address - Phone:406-868-7832
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-26
Last Update Date:2010-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1026101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)