Provider Demographics
NPI:1922268903
Name:LECLAIR, DANA KURT (LAC)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:KURT
Last Name:LECLAIR
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1127 ALDERSON AVE
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-4200
Mailing Address - Country:US
Mailing Address - Phone:406-245-7318
Mailing Address - Fax:406-248-5912
Practice Address - Street 1:1127 ALDERSON AVE
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-4200
Practice Address - Country:US
Practice Address - Phone:406-245-7318
Practice Address - Fax:406-248-5912
Is Sole Proprietor?:No
Enumeration Date:2008-06-12
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT933101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0730288Medicaid
MT0320620Medicaid