Provider Demographics
NPI:1124684279
Name:WALKER, LORILANE
Entity type:Individual
Prefix:
First Name:LORILANE
Middle Name:
Last Name:WALKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15086 LODGE POLE RD
Mailing Address - Street 2:
Mailing Address - City:DODSON
Mailing Address - State:MT
Mailing Address - Zip Code:59524-9656
Mailing Address - Country:US
Mailing Address - Phone:406-673-3003
Mailing Address - Fax:406-673-3053
Practice Address - Street 1:656 AGENCY MAIN ST
Practice Address - Street 2:
Practice Address - City:HARLEM
Practice Address - State:MT
Practice Address - Zip Code:59526-9455
Practice Address - Country:US
Practice Address - Phone:406-353-2525
Practice Address - Fax:406-353-2884
Is Sole Proprietor?:No
Enumeration Date:2019-05-14
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LAC-LIC-37511101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)