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General NPI Number Information
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NPI Number | 1750259933
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Entity Type | Individual
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Provider Name | JERAMY GERARD DICKMAN LAC
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Gender | Male
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Dates
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Enumeration Date | 10/28/2025
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Last Update Date | 10/28/2025
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Provider Practice Location Address
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Address Line | 1601 2ND AVE N STE 300W
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City | GREAT FALLS
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State | MT
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Zip | 59401-3243
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Country | US
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Telephone | 406-315-2028
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Fax | 866-813-9591
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Provider Business Mailing Address
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Address Line | 1601 2ND AVE N STE 300W
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City | GREAT FALLS
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State | MT
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Zip | 59401-3243
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Country | US
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Telephone | 406-315-2028
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Fax | 866-813-9591
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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-LAC-LIC-79062
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License Number State | MT
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