Provider Demographics
NPI:1508088865
Name:ERREBO, NANCY ELIZABETH (PSYD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:ELIZABETH
Last Name:ERREBO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 WEST BROADWAY
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802
Mailing Address - Country:US
Mailing Address - Phone:406-251-2659
Mailing Address - Fax:406-329-3006
Practice Address - Street 1:300 WEST BROADWAY
Practice Address - Street 2:SUITE 2A
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802
Practice Address - Country:US
Practice Address - Phone:406-251-2659
Practice Address - Fax:406-329-3006
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT265103T00000X
AZ1825103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT51081OtherBLUE CROSS BLUE SHIELD
MT0493376Medicaid
MT0493376Medicaid