Provider Demographics
NPI:1295764751
Name:SCHENCK, DIRK ERICK (LCPC)
Entity type:Individual
Prefix:
First Name:DIRK
Middle Name:ERICK
Last Name:SCHENCK
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:923 W CLARK ST
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:MT
Mailing Address - Zip Code:59047-2917
Mailing Address - Country:US
Mailing Address - Phone:240-731-0945
Mailing Address - Fax:215-220-3989
Practice Address - Street 1:1600 ELLIS ST
Practice Address - Street 2:SUITE 1C
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-8837
Practice Address - Country:US
Practice Address - Phone:240-731-0945
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-30
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC1476101YP2500X
PAPC2232101YP2500X
MTMT2330101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional