Provider Demographics
NPI:1134417645
Name:SCANLON, HEIDI PALMQUIST (LCPC, PLLC)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:PALMQUIST
Last Name:SCANLON
Suffix:
Gender:F
Credentials:LCPC, PLLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 MEDICAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-4925
Mailing Address - Country:US
Mailing Address - Phone:406-431-9388
Mailing Address - Fax:406-442-6935
Practice Address - Street 1:48 MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-4925
Practice Address - Country:US
Practice Address - Phone:406-431-9388
Practice Address - Fax:406-442-6935
Is Sole Proprietor?:No
Enumeration Date:2011-07-18
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1581101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional