Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | LAC-LAC-LIC-750 | MT |
NPI | 1003353186 |
---|---|
Provider Name | Eloise Youngman |
First Address | Poplar, MT 59255 |
Second Address | Poplar, MT 59255 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2017 |
Last Update Date | 26/01/2017 |