Provider Demographics
NPI:1386160976
Name:ANDERSON, LEANN JOYCE (LAC)
Entity type:Individual
Prefix:
First Name:LEANN
Middle Name:JOYCE
Last Name:ANDERSON
Suffix:
Gender:F
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 622
Mailing Address - Street 2:
Mailing Address - City:SUPERIOR
Mailing Address - State:MT
Mailing Address - Zip Code:59872-0622
Mailing Address - Country:US
Mailing Address - Phone:406-822-5422
Mailing Address - Fax:406-822-0786
Practice Address - Street 1:304 4TH AVE E
Practice Address - Street 2:
Practice Address - City:SUPERIOR
Practice Address - State:MT
Practice Address - Zip Code:59872
Practice Address - Country:US
Practice Address - Phone:406-822-5422
Practice Address - Fax:406-822-0786
Is Sole Proprietor?:No
Enumeration Date:2017-08-16
Last Update Date:2017-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LAC-LIC-18890101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)