Provider Demographics
NPI:1255460606
Name:KIRKPATRICK, DENISE ADELE (MED, LCPC)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:ADELE
Last Name:KIRKPATRICK
Suffix:
Gender:F
Credentials:MED, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1292
Mailing Address - Street 2:
Mailing Address - City:DILLON
Mailing Address - State:MT
Mailing Address - Zip Code:59725-1292
Mailing Address - Country:US
Mailing Address - Phone:406-925-0144
Mailing Address - Fax:844-727-7784
Practice Address - Street 1:110 S ATLANTIC ST
Practice Address - Street 2:
Practice Address - City:DILLON
Practice Address - State:MT
Practice Address - Zip Code:59725-2715
Practice Address - Country:US
Practice Address - Phone:406-925-0144
Practice Address - Fax:844-727-7784
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-03
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTLCPC-592101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT254202Medicaid
MT74775OtherBLUE CROSS BLUE SHIELD