Provider Demographics
NPI:1699079210
Name:CARR, BENJAMIN (LCPC)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:CARR
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 W SILVER ST
Mailing Address - Street 2:
Mailing Address - City:BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59701-1547
Mailing Address - Country:US
Mailing Address - Phone:406-529-5058
Mailing Address - Fax:
Practice Address - Street 1:305 W MERCURY ST STE 410
Practice Address - Street 2:
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-1659
Practice Address - Country:US
Practice Address - Phone:406-529-5058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-23
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1510101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1477745370Medicaid