Healthcare Provider Details

I. General information

NPI: 1871974246
Provider Name (Legal Business Name): RUTH STORY LCPC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2015
Last Update Date: 06/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 W LEGION ST # 5
WHITEHALL MT
59759-7762
US

IV. Provider business mailing address

313 W LEGION ST # 5
WHITEHALL MT
59759-7762
US

V. Phone/Fax

Practice location:
  • Phone: 406-579-7649
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: RUTH STORY
Title or Position: MANAGER
Credential: LCPC
Phone: 406-579-7649