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General NPI Number Information
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NPI Number | 1194107003
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Entity Type | Organization
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Legal Business Name | L ESPRIT PC
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Dates
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Enumeration Date | 06/27/2015
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Last Update Date | 12/20/2024
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Provider Practice Location Address
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Address Line | 120 S MAIN ST
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City | LIVINGSTON
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State | MT
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Zip | 59047-2624
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Country | US
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Telephone | 406-223-3621
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Fax |
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Provider Business Mailing Address
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Address Line | 111 N 3RD ST STE 1
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City | LIVINGSTON
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State | MT
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Zip | 59047-2645
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Country | US
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Telephone | 406-223-3621
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | CHANTELLE PLAUCHE
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Credential |
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Telephone | 406-223-3621
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number | 13496
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License Number State | MT
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Taxonomy #6
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 13496
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License Number State | MT
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