Provider Demographics
NPI:1770907982
Name:WESTERN, ALICIA (LCSW)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:WESTERN
Suffix:
Gender:F
Credentials:LCSW
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 1042
Mailing Address - Street 2:9446 US HWY 2
Mailing Address - City:TROY
Mailing Address - State:MT
Mailing Address - Zip Code:59935-1042
Mailing Address - Country:US
Mailing Address - Phone:509-540-1239
Mailing Address - Fax:
Practice Address - Street 1:320 E 2ND ST
Practice Address - Street 2:
Practice Address - City:LIBBY
Practice Address - State:MT
Practice Address - Zip Code:59923-2010
Practice Address - Country:US
Practice Address - Phone:406-283-6900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-07
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT46691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical