Provider Demographics
NPI:1043527302
Name:ROYAL, JEREMY (MA, LCPC)
Entity Type:Individual
Prefix:MR
First Name:JEREMY
Middle Name:
Last Name:ROYAL
Suffix:
Gender:M
Credentials:MA, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 N HARRIS ST UNIT 7886
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59604-7480
Mailing Address - Country:US
Mailing Address - Phone:406-792-6472
Mailing Address - Fax:
Practice Address - Street 1:3342 EVENING STAR DR
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59602-6064
Practice Address - Country:US
Practice Address - Phone:406-792-6472
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-08
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC-4866101YM0800X
MTBBH-LCPC-LIC-57158101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health