Provider Demographics
NPI:1952426843
Name:MCCAULEY, JEAN E (LAC)
Entity type:Individual
Prefix:MS
First Name:JEAN
Middle Name:E
Last Name:MCCAULEY
Suffix:
Gender:F
Credentials:LAC
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 452
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:MT
Mailing Address - Zip Code:59047-0452
Mailing Address - Country:US
Mailing Address - Phone:406-222-2812
Mailing Address - Fax:406-222-4764
Practice Address - Street 1:430 E PARK ST
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:MT
Practice Address - Zip Code:59047-2755
Practice Address - Country:US
Practice Address - Phone:406-222-2812
Practice Address - Fax:406-222-4764
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT281261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder