1972634731 NPI number — MRS. CONSTANCE MARIE PRESTON MA, LCPC

Table of content: MRS. CONSTANCE MARIE PRESTON MA, LCPC (NPI 1972634731)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972634731 NPI number — MRS. CONSTANCE MARIE PRESTON MA, LCPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PRESTON
Provider First Name:
CONSTANCE
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MA, LCPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PIQUETTE
Provider Other First Name:
CONSTANCE
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MA, LCPC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1972634731
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 375
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TOWNSEND
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59644-0375
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-266-5517
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
616 HELENA AVE
Provider Second Line Business Practice Location Address:
SUITE 305
Provider Business Practice Location Address City Name:
HELENA
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59601-3654
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-449-3120
Provider Business Practice Location Address Fax Number:
406-449-3125
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: 101YP2500X , with the licence number:  509 , 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: 0255374 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".




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