Provider Demographics
NPI:1194098046
Name:LUCKMAN, MARGOT (CRC, LCPC)
Entity type:Individual
Prefix:
First Name:MARGOT
Middle Name:
Last Name:LUCKMAN
Suffix:
Gender:F
Credentials:CRC, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2305 DUNCAN DRIVE
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802
Mailing Address - Country:US
Mailing Address - Phone:406-542-0820
Mailing Address - Fax:406-542-0843
Practice Address - Street 1:2305 DUNCAN DR
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-3455
Practice Address - Country:US
Practice Address - Phone:406-542-0820
Practice Address - Fax:406-542-0843
Is Sole Proprietor?:No
Enumeration Date:2012-02-22
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT277101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional