Provider Demographics
NPI:1548758048
Name:INGALLS, ZOE L (LCSW)
Entity Type:Individual
Prefix:
First Name:ZOE
Middle Name:L
Last Name:INGALLS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ZOE
Other - Middle Name:M
Other - Last Name:ROBINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1500 10TH AVE S STE 200
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405-2619
Mailing Address - Country:US
Mailing Address - Phone:406-866-0350
Mailing Address - Fax:406-406-0263
Practice Address - Street 1:1500 10TH AVE S STE 200
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-2619
Practice Address - Country:US
Practice Address - Phone:406-866-0350
Practice Address - Fax:406-406-0263
Is Sole Proprietor?:No
Enumeration Date:2018-04-30
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT301561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0MT0706773OtherBLUE CROSS-SHIELD OF MONTANA