Provider Demographics
NPI:1881908028
Name:LILBURN, JOHN CRAIG (MSW, LCSW)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:CRAIG
Last Name:LILBURN
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 7363
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59807-7363
Mailing Address - Country:US
Mailing Address - Phone:406-529-2619
Mailing Address - Fax:406-258-0491
Practice Address - Street 1:111 N HIGGINS AVE
Practice Address - Street 2:STE 422
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-4437
Practice Address - Country:US
Practice Address - Phone:406-529-2619
Practice Address - Fax:406-258-0491
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-29
Last Update Date:2016-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT9211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1881908028Medicaid
MTM011007586Medicare PIN