Provider Demographics
NPI:1194479303
Name:THORSON, ERIC (LAC)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:THORSON
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1732 S 72ND ST W
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59106-3538
Mailing Address - Country:US
Mailing Address - Phone:406-252-1306
Mailing Address - Fax:
Practice Address - Street 1:1732 S 72ND ST W
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59106-3538
Practice Address - Country:US
Practice Address - Phone:406-651-3111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-07
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBHLACLIC63164101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)