Provider Demographics
NPI:1932876190
Name:RIDDLE, CLARA I (LCPC)
Entity Type:Individual
Prefix:
First Name:CLARA
Middle Name:I
Last Name:RIDDLE
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34169 US HIGHWAY 2
Mailing Address - Street 2:
Mailing Address - City:LIBBY
Mailing Address - State:MT
Mailing Address - Zip Code:59923-8430
Mailing Address - Country:US
Mailing Address - Phone:406-283-3044
Mailing Address - Fax:406-293-3862
Practice Address - Street 1:34169 HWY2
Practice Address - Street 2:
Practice Address - City:LIBBY
Practice Address - State:MT
Practice Address - Zip Code:59923-5992
Practice Address - Country:US
Practice Address - Phone:406-283-3044
Practice Address - Fax:406-293-3862
Is Sole Proprietor?:No
Enumeration Date:2021-08-25
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-PCLC-LIC-49794101YM0800X
MTBBH-LCPC-LIC-57397101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health