Healthcare Provider Details

I. General information

NPI: 1194318154
Provider Name (Legal Business Name): CHARLA LUCIBELLO LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2021
Last Update Date: 02/19/2021
Certification Date: 02/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2755 COLONIAL DR
HELENA MT
59601-4926
US

IV. Provider business mailing address

PO BOX 5539
HELENA MT
59604-5539
US

V. Phone/Fax

Practice location:
  • Phone: 406-444-7500
  • Fax:
Mailing address:
  • Phone: 406-444-7500
  • Fax: 406-884-2085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number48274
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: