Provider Demographics
NPI:1598530149
Name:EREAUX, EAGLE W (LCPC CANDIDATE)
Entity Type:Individual
Prefix:
First Name:EAGLE
Middle Name:W
Last Name:EREAUX
Suffix:
Gender:F
Credentials:LCPC CANDIDATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3545 BRIARWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59101-9406
Mailing Address - Country:US
Mailing Address - Phone:406-901-5085
Mailing Address - Fax:
Practice Address - Street 1:3225 ROSEBUD DR
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-6001
Practice Address - Country:US
Practice Address - Phone:406-901-5085
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-22
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-PCLC-LIC-64772101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional