Provider Demographics
NPI:1073666830
Name:LOUSEN, CARMEN FOY (LCPC AND LAC)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:FOY
Last Name:LOUSEN
Suffix:
Gender:F
Credentials:LCPC AND LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 NORTH HIGGINS
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802
Mailing Address - Country:US
Mailing Address - Phone:406-728-1616
Mailing Address - Fax:
Practice Address - Street 1:210 NORTH HIGGINS
Practice Address - Street 2:SUITE 202
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802
Practice Address - Country:US
Practice Address - Phone:406-728-1616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT660101YA0400X
MT371LCPC101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT76071OtherBLUE CROSS BLUE SHIELD
MT0000255000Medicaid