Provider Demographics
NPI:1548391261
Name:WEBER, DARRYL L (LCPC)
Entity Type:Individual
Prefix:
First Name:DARRYL
Middle Name:L
Last Name:WEBER
Suffix:
Gender:M
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:PO BOX 22098
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59104-2098
Mailing Address - Country:US
Mailing Address - Phone:406-252-0713
Mailing Address - Fax:406-294-0967
Practice Address - Street 1:1643 LEWIS AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-4151
Practice Address - Country:US
Practice Address - Phone:406-252-0713
Practice Address - Fax:406-294-0967
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2009-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT383LCPC101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT000075311OtherBCBS
MT0254787Medicaid