Provider Demographics
NPI:1306326038
Name:JANES, ALLISON WILSON (LCSW)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:WILSON
Last Name:JANES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 160
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:MT
Mailing Address - Zip Code:59828-0160
Mailing Address - Country:US
Mailing Address - Phone:406-360-4292
Mailing Address - Fax:
Practice Address - Street 1:204 PINCKNEY ST
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:MT
Practice Address - Zip Code:59840-2514
Practice Address - Country:US
Practice Address - Phone:406-360-4292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-21
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT121261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical