Provider Demographics
NPI:1821617325
Name:DEBERRY, DAWNIE DAY
Entity Type:Individual
Prefix:
First Name:DAWNIE
Middle Name:DAY
Last Name:DEBERRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6850 UPPER BOX ELDER RD
Mailing Address - Street 2:
Mailing Address - City:BOX ELDER
Mailing Address - State:MT
Mailing Address - Zip Code:59521-9073
Mailing Address - Country:US
Mailing Address - Phone:406-395-4818
Mailing Address - Fax:406-395-4861
Practice Address - Street 1:6850 UPPER BOX ELDER RD
Practice Address - Street 2:
Practice Address - City:BOX ELDER
Practice Address - State:MT
Practice Address - Zip Code:59521-9073
Practice Address - Country:US
Practice Address - Phone:406-395-1617
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-14
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT3918101YA0400X
MT50013101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)