Provider Demographics
NPI:1750694162
Name:CHOQUETTE, LISA M (MS, LCPC)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:CHOQUETTE
Suffix:
Gender:F
Credentials:MS, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4904
Mailing Address - Street 2:
Mailing Address - City:BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59702-4904
Mailing Address - Country:US
Mailing Address - Phone:406-560-2646
Mailing Address - Fax:
Practice Address - Street 1:65 E BROADWAY ST
Practice Address - Street 2:
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-9305
Practice Address - Country:US
Practice Address - Phone:406-560-2646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-15
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor