Provider Demographics
NPI:1619234374
Name:COY, ISAAC C (LAC)
Entity Type:Individual
Prefix:
First Name:ISAAC
Middle Name:C
Last Name:COY
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2740 LIFESTYLE LN
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59602-0242
Mailing Address - Country:US
Mailing Address - Phone:406-370-7890
Mailing Address - Fax:406-443-5490
Practice Address - Street 1:2740 LIFESTYLE LN
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59602-0242
Practice Address - Country:US
Practice Address - Phone:406-370-7890
Practice Address - Fax:406-443-5490
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-19
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1257101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)