Healthcare Provider Details

I. General information

NPI: 1801688411
Provider Name (Legal Business Name): JULIE ANN DESHAZER ACLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2025
Last Update Date: 09/12/2025
Certification Date: 09/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2282 US HIGHWAY 93 S
KALISPELL MT
59901-8499
US

IV. Provider business mailing address

2282 US HIGHWAY 93 S
KALISPELL MT
59901-8499
US

V. Phone/Fax

Practice location:
  • Phone: 406-890-2570
  • Fax: 406-609-0794
Mailing address:
  • Phone: 406-890-2570
  • Fax: 406-609-0794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberBBH-PCLC-LIC-81383
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberBBH-ACLC-LIC-79690
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: