Provider Demographics
NPI:1679106108
Name:DEVERAUX, RACHEL ANNMARIE SARGENT (LAC)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:ANNMARIE SARGENT
Last Name:DEVERAUX
Suffix:
Gender:F
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:PO BOX 518
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59624-0518
Mailing Address - Country:US
Mailing Address - Phone:406-442-8774
Mailing Address - Fax:406-442-0428
Practice Address - Street 1:501 N PARK AVE
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-2703
Practice Address - Country:US
Practice Address - Phone:406-442-8774
Practice Address - Fax:406-442-0428
Is Sole Proprietor?:No
Enumeration Date:2020-02-12
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBHACLCLIC42628101YA0400X
MTBBH-LAC-LIC-48383101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)