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General NPI Number Information
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NPI Number | 1356092175
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Entity Type | Individual
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Provider Name | DUSTIN DUKE LCPC, LAC
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Gender | Male
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Dates
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Enumeration Date | 01/13/2022
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Last Update Date | 04/29/2024
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Provider Practice Location Address
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Address Line | 1629 AVENUE D STE A5
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City | BILLINGS
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State | MT
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Zip | 59102-3042
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Country | US
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Telephone | 406-200-4612
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 310
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City | SHEPHERD
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State | MT
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Zip | 59079-0310
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Country | US
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Telephone | 406-200-4612
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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 | BBH-LIC-LAC-55307
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License Number State | MT
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | BBH-LCPC-LIC-62191
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License Number State | MT
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