Healthcare Provider Details

I. General information

NPI: 1750138194
Provider Name (Legal Business Name): ALLY DZURKA MS, LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2024
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 CHAUCER ST
HELENA MT
59601-4315
US

IV. Provider business mailing address

6 CHAUCER ST
HELENA MT
59601-4315
US

V. Phone/Fax

Practice location:
  • Phone: 901-201-4363
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401226087
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number70736
License Number StateMT
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2571184
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: