Provider Demographics
NPI:1306069521
Name:VOLKMANN, CLARK PETER (LCPC)
Entity type:Individual
Prefix:MR
First Name:CLARK
Middle Name:PETER
Last Name:VOLKMANN
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 MILNOR LAKE ROAD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MT
Mailing Address - Zip Code:59935
Mailing Address - Country:US
Mailing Address - Phone:406-295-5442
Mailing Address - Fax:406-295-9655
Practice Address - Street 1:912 MAIN AVE
Practice Address - Street 2:
Practice Address - City:LIBBY
Practice Address - State:MT
Practice Address - Zip Code:59923-1820
Practice Address - Country:US
Practice Address - Phone:406-293-4644
Practice Address - Fax:406-293-7644
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT279101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT257142Medicaid
MT74501OtherBCBS OF MT