Provider Demographics
NPI:1619094596
Name:LEMONS, FRED (MED)
Entity Type:Individual
Prefix:MR
First Name:FRED
Middle Name:
Last Name:LEMONS
Suffix:
Gender:M
Credentials:MED
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 513
Mailing Address - Street 2:
Mailing Address - City:BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59703-0513
Mailing Address - Country:US
Mailing Address - Phone:406-582-4499
Mailing Address - Fax:
Practice Address - Street 1:170 ANDREA DR
Practice Address - Street 2:# 10
Practice Address - City:BELGRADE
Practice Address - State:MT
Practice Address - Zip Code:59714-8945
Practice Address - Country:US
Practice Address - Phone:406-582-4499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2014-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT35101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health