Provider Demographics
NPI:1619067766
Name:HODGES, GRACE (LCPC)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:HODGES
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 S RALEIGH ST
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-5169
Mailing Address - Country:US
Mailing Address - Phone:406-447-6565
Mailing Address - Fax:406-442-7271
Practice Address - Street 1:616 HELENA AVE STE 301
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-3654
Practice Address - Country:US
Practice Address - Phone:406-447-6565
Practice Address - Fax:406-442-7271
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTLCPC #354101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT74663OtherBLUE CROSS BLUE SHIELD
MT0255112Medicaid