Provider Demographics
NPI:1215209408
Name:TRIBBLE, ERICA JO (LCSW)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:JO
Last Name:TRIBBLE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 17531
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59808-7531
Mailing Address - Country:US
Mailing Address - Phone:406-370-4294
Mailing Address - Fax:
Practice Address - Street 1:714 KENSINGTON AVE
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-5720
Practice Address - Country:US
Practice Address - Phone:406-370-4294
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-02
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT10571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical