Provider Demographics
NPI:1578092375
Name:ABBOTT, LORETTA JUDITH (LCSW)
Entity Type:Individual
Prefix:
First Name:LORETTA
Middle Name:JUDITH
Last Name:ABBOTT
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:PO BOX 546
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59845-0546
Mailing Address - Country:US
Mailing Address - Phone:406-207-5380
Mailing Address - Fax:
Practice Address - Street 1:56 GANNAWAY LOOP
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:MT
Practice Address - Zip Code:59845-0546
Practice Address - Country:US
Practice Address - Phone:406-207-5380
Practice Address - Fax:406-207-5380
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-06
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YS0200X
MT648071041C0700X
1041S0200X
CA712571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool