Provider Demographics
NPI:1326490434
Name:LUFT, CARLYE
Entity Type:Individual
Prefix:
First Name:CARLYE
Middle Name:
Last Name:LUFT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 MEADOW BROOK RD
Mailing Address - Street 2:
Mailing Address - City:BELGRADE
Mailing Address - State:MT
Mailing Address - Zip Code:59714-9578
Mailing Address - Country:US
Mailing Address - Phone:406-404-6244
Mailing Address - Fax:
Practice Address - Street 1:47995 GALLATIN RD STE 107
Practice Address - Street 2:
Practice Address - City:GALLATIN GATEWAY
Practice Address - State:MT
Practice Address - Zip Code:59730-8648
Practice Address - Country:US
Practice Address - Phone:406-404-6244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-13
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTAHC-NAT-LIC-1443175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath