Provider Demographics
NPI:1720306848
Name:BERG, ALEECE JOLENE (LCSW, LAC)
Entity type:Individual
Prefix:
First Name:ALEECE
Middle Name:JOLENE
Last Name:BERG
Suffix:
Gender:F
Credentials:LCSW, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:891 STAR RD
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59602-8137
Mailing Address - Country:US
Mailing Address - Phone:406-461-1693
Mailing Address - Fax:
Practice Address - Street 1:1305 11TH AVE
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-3919
Practice Address - Country:US
Practice Address - Phone:406-431-2908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-13
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTLAC-LAC-LIC 1347101YA0400X
MTSWP-LCSW-LIC-24191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)