Healthcare Provider Details

I. General information

NPI: 1255460606
Provider Name (Legal Business Name): DENISE ADELE KIRKPATRICK MED, LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2007
Last Update Date: 01/19/2024
Certification Date: 01/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 S ATLANTIC ST
DILLON MT
59725-2715
US

IV. Provider business mailing address

PO BOX 1292
DILLON MT
59725-1292
US

V. Phone/Fax

Practice location:
  • Phone: 406-925-0144
  • Fax: 844-727-7784
Mailing address:
  • Phone: 406-925-0144
  • Fax: 844-727-7784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLCPC-592
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLCPC-592
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: