Provider Demographics
NPI:1205800281
Name:BRONEC, ELIZABETH JEAN (LCPC)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:JEAN
Last Name:BRONEC
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 BRECKENRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-4432
Mailing Address - Country:US
Mailing Address - Phone:406-443-5377
Mailing Address - Fax:
Practice Address - Street 1:111 N LAST CHANCE GULCH ST
Practice Address - Street 2:SUITE 2A
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-4125
Practice Address - Country:US
Practice Address - Phone:406-443-1990
Practice Address - Fax:406-443-1391
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1200 LCPC101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0000742560OtherBLUE CROSS/SHIELD OF MONT
MT0257278Medicaid