Provider Demographics
NPI:1972229706
Name:ANDERSON, JULIE ANNE (LAC)
Entity Type:Individual
Prefix:MS
First Name:JULIE
Middle Name:ANNE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 S 10TH ST
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:MT
Mailing Address - Zip Code:59047-2519
Mailing Address - Country:US
Mailing Address - Phone:406-671-8900
Mailing Address - Fax:
Practice Address - Street 1:202 S 2ND ST
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:MT
Practice Address - Zip Code:59047-3002
Practice Address - Country:US
Practice Address - Phone:533-540-6222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-13
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LAC-LIC-49536101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTBBH-LAC-LIC-49536OtherMONTANA BOARD OF BEHAVIORAL HEALTH