Provider Demographics
NPI:1295502540
Name:EAGLE VISION LLC
Entity type:Organization
Organization Name:EAGLE VISION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:EAGLE
Authorized Official - Middle Name:W
Authorized Official - Last Name:EREAUX
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC CANDIDATE
Authorized Official - Phone:406-901-5085
Mailing Address - Street 1:3225 ROSEBUD DR
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-6001
Mailing Address - Country:US
Mailing Address - Phone:406-901-5085
Mailing Address - Fax:
Practice Address - Street 1:3225 ROSEBUD DR
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-6001
Practice Address - Country:US
Practice Address - Phone:406-901-5085
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-07
Last Update Date:2023-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty