Provider Demographics
NPI:1740725787
Name:ACTON, MARTHA JO (LAC)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:JO
Last Name:ACTON
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:MS
Other - First Name:MARTHA
Other - Middle Name:JO
Other - Last Name:ACTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:PO BOX 31633
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59107-1633
Mailing Address - Country:US
Mailing Address - Phone:406-670-3148
Mailing Address - Fax:
Practice Address - Street 1:8010 MOLT RD
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59106-9604
Practice Address - Country:US
Practice Address - Phone:406-670-3148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-29
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LAC-LIC-3329101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTBBH-LAC-LIC-3329OtherMONTANA BOARD OF BEHAVIORAL HEALTH