Provider Demographics
NPI:1477550549
Name:PURDY, ELISABETH MONTANA (LCPC)
Entity Type:Individual
Prefix:
First Name:ELISABETH
Middle Name:MONTANA
Last Name:PURDY
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 23RD AVE NE
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59404-1445
Mailing Address - Country:US
Mailing Address - Phone:406-453-6784
Mailing Address - Fax:406-453-6793
Practice Address - Street 1:120 23RD AVE NE
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59404-1445
Practice Address - Country:US
Practice Address - Phone:406-453-6784
Practice Address - Fax:406-453-6793
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTLCPC 1189101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTGROUPOtherGROUP DEFAULT
MT0256737Medicaid