Provider Demographics
NPI:1124584578
Name:JEFF C. RICHARDSON, LAC LLC
Entity Type:Organization
Organization Name:JEFF C. RICHARDSON, LAC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED ADDICTION COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-783-7060
Mailing Address - Street 1:127 E FRONT ST
Mailing Address - Street 2:
Mailing Address - City:WOLF POINT
Mailing Address - State:MT
Mailing Address - Zip Code:59201-1402
Mailing Address - Country:US
Mailing Address - Phone:406-653-2212
Mailing Address - Fax:406-653-2112
Practice Address - Street 1:127 E FRONT ST
Practice Address - Street 2:
Practice Address - City:WOLF POINT
Practice Address - State:MT
Practice Address - Zip Code:59201-1402
Practice Address - Country:US
Practice Address - Phone:406-653-2212
Practice Address - Fax:406-653-2112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-11
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty