Provider Demographics
NPI:1184210692
Name:MACARTHUR, MOSES RUSSEL (LAC)
Entity Type:Individual
Prefix:MR
First Name:MOSES
Middle Name:RUSSEL
Last Name:MACARTHUR
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 CENTRAL AVE STE 408
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59401-3141
Mailing Address - Country:US
Mailing Address - Phone:406-205-3433
Mailing Address - Fax:406-315-2327
Practice Address - Street 1:600 CENTRAL AVE STE 408
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59401-3141
Practice Address - Country:US
Practice Address - Phone:406-205-3433
Practice Address - Fax:406-315-2327
Is Sole Proprietor?:No
Enumeration Date:2020-12-18
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
MTBBH-LAC-LIC-62725101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)