Provider Demographics
NPI:1942238001
Name:BLOCK, LAURA BETH (MED, LCPC)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:BETH
Last Name:BLOCK
Suffix:
Gender:F
Credentials:MED, LCPC
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:BLOCK
Other - Last Name:LOWER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCPC
Mailing Address - Street 1:531 W BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59701-9104
Mailing Address - Country:US
Mailing Address - Phone:406-580-4685
Mailing Address - Fax:
Practice Address - Street 1:531 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-9104
Practice Address - Country:US
Practice Address - Phone:406-580-4685
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-29
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1129101Y00000X
MTBBH-LCPC-LIC-1129101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0256360Medicaid