Provider Demographics
NPI:1528614351
Name:AZURE, LINDA M (LAC)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:M
Last Name:AZURE
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 1:656 AGENCY MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HARLEM
Mailing Address - State:MT
Mailing Address - Zip Code:59526-9455
Mailing Address - Country:US
Mailing Address - Phone:406-353-4175
Mailing Address - Fax:
Practice Address - Street 1:122 ARENA AVE.
Practice Address - Street 2:
Practice Address - City:HARLEM
Practice Address - State:MT
Practice Address - Zip Code:59526
Practice Address - Country:US
Practice Address - Phone:406-353-4175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-16
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LAC-LIC-37556101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)