Provider Demographics
NPI:1891994000
Name:LAMERE -CAPLETTE, TRACI NICOLE (LAC 55752)
Entity Type:Individual
Prefix:MRS
First Name:TRACI
Middle Name:NICOLE
Last Name:LAMERE -CAPLETTE
Suffix:
Gender:F
Credentials:LAC 55752
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:RR 1 BOX 664
Practice Address - Street 2:
Practice Address - City:BOX ELDER
Practice Address - State:MT
Practice Address - Zip Code:59521-9797
Practice Address - Country:US
Practice Address - Phone:406-395-4818
Practice Address - Fax:406-395-4861
Is Sole Proprietor?:No
Enumeration Date:2007-07-17
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT55752101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)