Provider Demographics
NPI:1740044635
Name:IGLEHART, DEMARCUS (LCPC)
Entity type:Individual
Prefix:MR
First Name:DEMARCUS
Middle Name:
Last Name:IGLEHART
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:MARCUS
Other - Middle Name:
Other - Last Name:IGLEHART
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2507 OTTAWA ST
Mailing Address - Street 2:
Mailing Address - City:BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59701-6207
Mailing Address - Country:US
Mailing Address - Phone:254-214-7555
Mailing Address - Fax:
Practice Address - Street 1:2507 OTTAWA ST
Practice Address - Street 2:
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-6207
Practice Address - Country:US
Practice Address - Phone:254-214-7555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-12
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID8171941101YP2500X
MT69961101YP2500X
MT76170101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional