Provider Demographics
NPI:1629302914
Name:SHORE, WALTER F (MS, LAC, NCAC II)
Entity Type:Individual
Prefix:MR
First Name:WALTER
Middle Name:F
Last Name:SHORE
Suffix:
Gender:M
Credentials:MS, LAC, NCAC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 CARAVAN AVE
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59105-2801
Mailing Address - Country:US
Mailing Address - Phone:406-794-1393
Mailing Address - Fax:
Practice Address - Street 1:208 N 29TH ST
Practice Address - Street 2:SUITE 234
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-1985
Practice Address - Country:US
Practice Address - Phone:406-794-1393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-20
Last Update Date:2009-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT838101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)