Provider Demographics
NPI:1336513225
Name:SEDOR, ELOISE FAYE
Entity Type:Individual
Prefix:
First Name:ELOISE
Middle Name:FAYE
Last Name:SEDOR
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 1:214 E MENDENHALL ST
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-3638
Mailing Address - Country:US
Mailing Address - Phone:406-585-1360
Mailing Address - Fax:
Practice Address - Street 1:214 E MENDENHALL ST
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-3638
Practice Address - Country:US
Practice Address - Phone:406-585-1360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-16
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
MTBBH-LCPC-LIC-50579101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor