Provider Demographics
NPI:1962970590
Name:LACOUNTE, MICOLE FOUST (ACLC)
Entity type:Individual
Prefix:
First Name:MICOLE
Middle Name:FOUST
Last Name:LACOUNTE
Suffix:
Gender:M
Credentials:ACLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2620 CONNERY WAY
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59808-1325
Mailing Address - Country:US
Mailing Address - Phone:406-203-9948
Mailing Address - Fax:406-203-9949
Practice Address - Street 1:2620 CONNERY WAY
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59808-1325
Practice Address - Country:US
Practice Address - Phone:406-203-9948
Practice Address - Fax:406-203-9949
Is Sole Proprietor?:No
Enumeration Date:2018-11-13
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-ACLC-LIC-63769101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)