Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | BBH-LCPC-LIC-19614 | MT |
NPI | 1003358698 |
---|---|
Provider Name | Leigh Dicks |
First Address | Seeley Lake, MT 59868-0682 |
Second Address | Butte, MT 59701-9704 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2016 |
Last Update Date | 14/11/2016 |