Provider Demographics
NPI:1356416218
Name:WAHLER, ERIC JONATHAN (LCPC)
Entity type:Individual
Prefix:MR
First Name:ERIC
Middle Name:JONATHAN
Last Name:WAHLER
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 1:616 HELENA AVE
Mailing Address - Street 2:#301
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-3654
Mailing Address - Country:US
Mailing Address - Phone:406-457-0579
Mailing Address - Fax:406-442-7271
Practice Address - Street 1:616 HELENA AVE
Practice Address - Street 2:#301
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-3654
Practice Address - Country:US
Practice Address - Phone:406-457-0579
Practice Address - Fax:406-442-7271
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT292101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0255489Medicaid
MT074996OtherBLUE CROSS-BLUE SHIELD