Provider Demographics
NPI:1457692451
Name:CLORE CASTO, REBECKA (LCPC)
Entity Type:Individual
Prefix:
First Name:REBECKA
Middle Name:
Last Name:CLORE CASTO
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:REBECKA
Other - Middle Name:ANN
Other - Last Name:CLORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:985 PIN AVE
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-6119
Mailing Address - Country:US
Mailing Address - Phone:406-640-0561
Mailing Address - Fax:
Practice Address - Street 1:502 S 19TH AVE
Practice Address - Street 2:#200
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-4055
Practice Address - Country:US
Practice Address - Phone:406-586-2626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-15
Last Update Date:2013-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT4470101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health