Provider Demographics
NPI:1457617151
Name:MINCKLER, RODNEY A (LCPC)
Entity Type:Individual
Prefix:
First Name:RODNEY
Middle Name:A
Last Name:MINCKLER
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 1:216 E 4TH ST
Mailing Address - Street 2:
Mailing Address - City:ANACONDA
Mailing Address - State:MT
Mailing Address - Zip Code:59711-3002
Mailing Address - Country:US
Mailing Address - Phone:406-560-6167
Mailing Address - Fax:
Practice Address - Street 1:216 E 4TH ST
Practice Address - Street 2:
Practice Address - City:ANACONDA
Practice Address - State:MT
Practice Address - Zip Code:59711-3002
Practice Address - Country:US
Practice Address - Phone:406-560-6167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-06
Last Update Date:2012-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1602-LCPC101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health