Healthcare Provider Details

I. General information

NPI: 1124531785
Provider Name (Legal Business Name): JAMES MARION DEL DUCA III LAC-CANDIDATE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2017
Last Update Date: 11/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 HAGGERTY LN STE 2
BOZEMAN MT
59715-1780
US

IV. Provider business mailing address

333 HAGGERTY LN STE 2
BOZEMAN MT
59715-1780
US

V. Phone/Fax

Practice location:
  • Phone: 406-599-2463
  • Fax:
Mailing address:
  • Phone: 406-599-2463
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberBBH-ACLC-LIC-14219
License Number StateMT
# 3
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: