Provider Demographics
NPI:1598215014
Name:FREGOSO, ALEXIA A (LCSW)
Entity Type:Individual
Prefix:
First Name:ALEXIA
Middle Name:A
Last Name:FREGOSO
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 1:11 W MAIN ST STE 207
Mailing Address - Street 2:
Mailing Address - City:BELGRADE
Mailing Address - State:MT
Mailing Address - Zip Code:59714-3735
Mailing Address - Country:US
Mailing Address - Phone:406-388-2725
Mailing Address - Fax:
Practice Address - Street 1:11 W MAIN ST STE 207
Practice Address - Street 2:
Practice Address - City:BELGRADE
Practice Address - State:MT
Practice Address - Zip Code:59714-3735
Practice Address - Country:US
Practice Address - Phone:406-388-2725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-07
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT147991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical