Provider Demographics
NPI:1255521829
Name:LAEUPPLE, CORALIE (LCSW)
Entity type:Individual
Prefix:
First Name:CORALIE
Middle Name:
Last Name:LAEUPPLE
Suffix:
Gender:F
Credentials:LCSW
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 211
Mailing Address - Street 2:
Mailing Address - City:ELMO
Mailing Address - State:MT
Mailing Address - Zip Code:59915-0211
Mailing Address - Country:US
Mailing Address - Phone:406-849-6121
Mailing Address - Fax:406-494-1724
Practice Address - Street 1:312 4TH AVE E
Practice Address - Street 2:
Practice Address - City:POLSON
Practice Address - State:MT
Practice Address - Zip Code:59860-2314
Practice Address - Country:US
Practice Address - Phone:406-883-6229
Practice Address - Fax:406-883-6365
Is Sole Proprietor?:No
Enumeration Date:2007-07-30
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT7601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT760OtherSTATE OF MONTANA LICENSE