1548391261 NPI number — DARRYL L WEBER LCPC

Table of content: DARRYL L WEBER LCPC (NPI 1548391261)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548391261 NPI number — DARRYL L WEBER LCPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WEBER
Provider First Name:
DARRYL
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCPC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548391261
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/13/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 22098
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BILLINGS
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59104-2098
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-252-0713
Provider Business Mailing Address Fax Number:
406-294-0967

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1643 LEWIS AVE
Provider Second Line Business Practice Location Address:
SUITE 3
Provider Business Practice Location Address City Name:
BILLINGS
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59102-4151
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-252-0713
Provider Business Practice Location Address Fax Number:
406-294-0967
Provider Enumeration Date:
03/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  383LCPC , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000075311 . This is a "BCBS" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".
  • Identifier: 0254787 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".




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