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General NPI Number Information
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NPI Number | 1770235764
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Entity Type | Individual
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Provider Name | TERRY LEE LAC, SWLC
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Gender | Male
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Dates
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Enumeration Date | 01/21/2022
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Last Update Date | 12/02/2025
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Provider Practice Location Address
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Address Line | 6300 US HIGHWAY 93 S
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City | WHITEFISH
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State | MT
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Zip | 59937-8235
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Country | US
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Telephone | 406-260-5516
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Fax |
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Provider Business Mailing Address
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Address Line | 6300 US HIGHWAY 93 S
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City | WHITEFISH
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State | MT
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Zip | 59937-8235
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Country | US
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Telephone | 406-260-5516
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | BBH-SLWC-LIC-77078
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License Number State | MT
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Taxonomy #2
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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-55813
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License Number State | MT
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