Provider Demographics
NPI:1407051857
Name:DYNNESON, VERLA VESTER (EDD, LCPC)
Entity Type:Individual
Prefix:DR
First Name:VERLA
Middle Name:VESTER
Last Name:DYNNESON
Suffix:
Gender:F
Credentials:EDD, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 S 5TH ST
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:MT
Mailing Address - Zip Code:59047-3427
Mailing Address - Country:US
Mailing Address - Phone:406-222-8191
Mailing Address - Fax:
Practice Address - Street 1:318 S 5TH ST
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:MT
Practice Address - Zip Code:59047-3427
Practice Address - Country:US
Practice Address - Phone:406-222-8191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT80101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT253181Medicaid
MT075120OtherBLUE CROSS AND BLUE SHIEL