Provider Demographics
NPI:1518008077
Name:LEROUX, JUDY P (LCSW)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:P
Last Name:LEROUX
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 S EWING ST
Mailing Address - Street 2:SUITE 424
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-5938
Mailing Address - Country:US
Mailing Address - Phone:406-459-8111
Mailing Address - Fax:406-225-4393
Practice Address - Street 1:25 S EWING ST
Practice Address - Street 2:SUITE 424
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-5938
Practice Address - Country:US
Practice Address - Phone:406-459-8111
Practice Address - Fax:406-225-4393
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MT6091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0503591Medicaid
MT70835Medicare UPIN
MT0503591Medicaid