Provider Demographics
NPI:1073627246
Name:HEPPE, TARI KAY (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:TARI
Middle Name:KAY
Last Name:HEPPE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:TARI
Other - Middle Name:KAY
Other - Last Name:CHANDLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 11
Mailing Address - Street 2:406 GARBER NUMBER 1
Mailing Address - City:PLAINS
Mailing Address - State:MT
Mailing Address - Zip Code:59859-0011
Mailing Address - Country:US
Mailing Address - Phone:406-546-8095
Mailing Address - Fax:406-826-6826
Practice Address - Street 1:406 GARBER NO 1
Practice Address - Street 2:
Practice Address - City:PLAINS
Practice Address - State:MT
Practice Address - Zip Code:59859-0011
Practice Address - Country:US
Practice Address - Phone:406-546-8095
Practice Address - Fax:406-826-6826
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT673LCSW1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0503404Medicaid