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General NPI Number Information
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NPI Number | 1033793419
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Entity Type | Individual
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Provider Name | VALERIE JANE ALLEN LACC
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Gender | Female
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Dates
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Enumeration Date | 05/11/2021
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Last Update Date | 05/11/2021
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Provider Practice Location Address
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Address Line | 111 N BROADWAY AVE
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City | RED LODGE
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State | MT
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Zip | 59068-9031
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Country | US
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Telephone | 406-446-0337
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Fax | 406-646-3020
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Provider Business Mailing Address
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Address Line | 112 TWO MILE BRIDGE RD
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City | ROBERTS
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State | MT
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Zip | 59070-9410
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Country | US
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Telephone | 406-850-0081
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 41855
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License Number State | MT
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