Provider Demographics
NPI:1538797808
Name:ALON, MEIRA ALIZA
Entity type:Individual
Prefix:
First Name:MEIRA
Middle Name:ALIZA
Last Name:ALON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 BAXTER LN
Mailing Address - Street 2:11151
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-4173
Mailing Address - Country:US
Mailing Address - Phone:406-426-1450
Mailing Address - Fax:
Practice Address - Street 1:2201 BAXTER LN
Practice Address - Street 2:11151
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-4173
Practice Address - Country:US
Practice Address - Phone:406-426-1450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-31
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LAC-LIC-39896101YA0400X
MN305229101YA0400X
MTBBH-LCPC-LIC-50087101YM0800X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health