Provider Demographics
NPI:1134267354
Name:AUERHAMMER, THOMAS RICHARD (LCPC)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:RICHARD
Last Name:AUERHAMMER
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:836 HOLT DR STE 321
Mailing Address - Street 2:
Mailing Address - City:BIGFORK
Mailing Address - State:MT
Mailing Address - Zip Code:59911-6272
Mailing Address - Country:US
Mailing Address - Phone:406-837-1289
Mailing Address - Fax:406-837-2189
Practice Address - Street 1:836 HOLT DR STE 321
Practice Address - Street 2:
Practice Address - City:BIGFORK
Practice Address - State:MT
Practice Address - Zip Code:59911-6272
Practice Address - Country:US
Practice Address - Phone:406-837-1289
Practice Address - Fax:406-837-2189
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT974LCPC101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0253742Medicaid
MT744873OtherBLUE CROSS BLUE SHIELD