Provider Demographics
NPI:1306935366
Name:IRWIN, ROBERT 'DENNY' D (LAC)
Entity type:Individual
Prefix:
First Name:ROBERT 'DENNY'
Middle Name:D
Last Name:IRWIN
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:PO BOX 44
Mailing Address - Street 2:
Mailing Address - City:LEWISTOWN
Mailing Address - State:MT
Mailing Address - Zip Code:59457-0044
Mailing Address - Country:US
Mailing Address - Phone:406-538-7483
Mailing Address - Fax:406-538-7491
Practice Address - Street 1:212 WENDELL AVE
Practice Address - Street 2:
Practice Address - City:LEWISTOWN
Practice Address - State:MT
Practice Address - Zip Code:59457
Practice Address - Country:US
Practice Address - Phone:406-538-7483
Practice Address - Fax:406-538-7491
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1158101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)