Active NPI
Dan Donnelly, LAC
- Addiction (Substance Use Disorder) Counselor
- Kalispell, MT
National Provider Identifier
1114058922
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 1049
- Practice address
- 1312 N Meridian Rd
Kalispell, MT 59901-3095 - Phone
- (406) 756-6453
- Fax
- (406) 756-8546
- NPI assigned
- Mar 7, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 1049 | MT | Primary |
Addresses
Primary practice location
1312 N Meridian Rd
Kalispell, MT 59901-3095
Mailing address
1312 N Meridian Rd
Kalispell, MT 59901-3095
Phone (406) 756-6453
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0320372 | Medicaid | MT | |
| 760640 | Other | MO | CHIP |
| 0000076391 | Other | MT | BLUE CROSS BLUE SHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1049 | MT | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173225600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1114058922",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1312 N MERIDIAN RD",
"city": "KALISPELL",
"state": "MT",
"postal_code": "599013095",
"telephone_number": "406-756-6453",
"fax_number": "406-756-8546"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1312 N MERIDIAN RD",
"city": "KALISPELL",
"state": "MT",
"postal_code": "599013095",
"telephone_number": "406-756-6453",
"fax_number": "406-756-8546"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DONNELLY",
"first_name": "DAN",
"name_prefix": "Mr.",
"credential": "LAC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-03-07",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "MT",
"license": "1049",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0320372",
"state": "MT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CHIP",
"identifier": "760640",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "0000076391",
"state": "MT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Kalispell, MT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.