Provider Demographics
NPI:1962748426
Name:FALCON, ALFRED D (LAC LCPC)
Entity type:Individual
Prefix:
First Name:ALFRED
Middle Name:D
Last Name:FALCON
Suffix:
Gender:M
Credentials:LAC LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4635 RUTH AVE
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59101-4830
Mailing Address - Country:US
Mailing Address - Phone:406-860-6228
Mailing Address - Fax:
Practice Address - Street 1:1500 POLY DR STE 203
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-1748
Practice Address - Country:US
Practice Address - Phone:406-860-6228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-02
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LAC-LIC-2613101YA0400X
MT7613104100000X
MTBBH-LCPC-LIC-7613101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker