Provider Demographics
NPI:1598774440
Name:BREWER, EARL LEROY (LCPC)
Entity Type:Individual
Prefix:MR
First Name:EARL
Middle Name:LEROY
Last Name:BREWER
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 1:190 ROSEBUD STREET
Mailing Address - Street 2:P.O. BOX 1176
Mailing Address - City:FORSYTH
Mailing Address - State:MT
Mailing Address - Zip Code:59327-1176
Mailing Address - Country:US
Mailing Address - Phone:406-351-1820
Mailing Address - Fax:406-346-1538
Practice Address - Street 1:1075 EAST MAIN STREET
Practice Address - Street 2:
Practice Address - City:FORSYTH
Practice Address - State:MT
Practice Address - Zip Code:59327
Practice Address - Country:US
Practice Address - Phone:406-351-1820
Practice Address - Fax:406-346-1538
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1247101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT743280OtherBLUECROSS BLUESHIELD
MT257062Medicaid