Provider Demographics
NPI:1063862472
Name:ROAN, ELIZABETH ANN I (LAC)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:ANN
Last Name:ROAN
Suffix:I
Gender:F
Credentials:LAC
Other - Prefix:MRS
Other - First Name:BETTY
Other - Middle Name:ANN
Other - Last Name:ROAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC
Mailing Address - Street 1:3205 COUNTRY CLUB CIR
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-0666
Mailing Address - Country:US
Mailing Address - Phone:406-281-0948
Mailing Address - Fax:406-534-3887
Practice Address - Street 1:3205 COUNTRY CLUB CIR
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-0666
Practice Address - Country:US
Practice Address - Phone:406-281-0948
Practice Address - Fax:406-534-3887
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-16
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LAC-LIC-319101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)