Provider Demographics
NPI:1154434827
Name:KRUSHEFSKI, EMILY ANN (LCPC)
Entity type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:ANN
Last Name:KRUSHEFSKI
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:MS
Other - First Name:EMILY
Other - Middle Name:ANN
Other - Last Name:LEDDICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1940 W DICKERSON ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-6851
Mailing Address - Country:US
Mailing Address - Phone:406-522-0410
Mailing Address - Fax:406-587-2292
Practice Address - Street 1:1940 W DICKERSON ST
Practice Address - Street 2:SUITE 102
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-6851
Practice Address - Country:US
Practice Address - Phone:406-522-0410
Practice Address - Fax:406-587-2292
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT941101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT256071Medicaid
MT744593OtherBLUE CHIP PROVIDER ID