Provider Demographics
NPI:1295898559
Name:THATCHER, LAURIE W (LCSW)
Entity type:Individual
Prefix:MS
First Name:LAURIE
Middle Name:W
Last Name:THATCHER
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 6774
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59771-6774
Mailing Address - Country:US
Mailing Address - Phone:406-580-9160
Mailing Address - Fax:
Practice Address - Street 1:105 W MAIN ST
Practice Address - Street 2:SUITE 2E
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-5016
Practice Address - Country:US
Practice Address - Phone:406-580-9160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT4611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT70413OtherBCBS
MT501262Medicaid
MT501262Medicaid