Provider Demographics
NPI:1811188238
Name:KNUDSON, DEBBY LOUISE (LAC)
Entity Type:Individual
Prefix:
First Name:DEBBY
Middle Name:LOUISE
Last Name:KNUDSON
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 1:925 CENTER DR
Mailing Address - Street 2:
Mailing Address - City:HAVRE
Mailing Address - State:MT
Mailing Address - Zip Code:59501-4254
Mailing Address - Country:US
Mailing Address - Phone:406-265-1262
Mailing Address - Fax:
Practice Address - Street 1:220 3RD AVE STE 409
Practice Address - Street 2:
Practice Address - City:HAVRE
Practice Address - State:MT
Practice Address - Zip Code:59501-3554
Practice Address - Country:US
Practice Address - Phone:406-561-0929
Practice Address - Fax:406-879-4001
Is Sole Proprietor?:No
Enumeration Date:2007-08-09
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1212101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0320535Medicaid