Provider Demographics
NPI:1942306089
Name:DEATON, ROBERT LESTER (MSW EDD LCSW)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LESTER
Last Name:DEATON
Suffix:
Gender:M
Credentials:MSW EDD LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2710 MULBERRY LANE
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59804-5102
Mailing Address - Country:US
Mailing Address - Phone:406-543-7704
Mailing Address - Fax:406-543-7704
Practice Address - Street 1:3700 SOUTH RUSSELL
Practice Address - Street 2:SUITE 120B
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801
Practice Address - Country:US
Practice Address - Phone:406-370-0650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT112104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0503693Medicaid
MT71015OtherMT BLUE CROSS
MT71015OtherCHIPS
MT71015OtherCHIPS