Mary Louise Deroche, L.A.C.
Individual provider Active NPI Addiction (Substance Use Disorder) Counselor · Browning, MT
NPI 1649828641 · NPPES record last updated Nov 27, 2023
Key facts
- NPI
- 1649828641
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Addiction (Substance Use Disorder) Counselor 101YA0400X
- License
- 786 (MT)
- Practice address
- 807 North Piegan Street
Browning, MT 59417 - Phone
- (406) 338-6330
- NPI assigned
- Sep 3, 2019
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 786 | MT | MD | Chiropractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Crystal Creek Lodge | Current |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 786 | MT | Yes |
Addresses
Primary practice location
807 North Piegan Street
Browning, MT 59417
Mailing address
PO Box 450
Browning, MT 59417-0450
Phone (406) 338-6330
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285854885 | Medicaid | MT |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | crytalcreeklodge@blackfeetnation.com | CRYSTAL CREEK LODGE |
Other providers in Browning, MT
- Leland Louis Crawford
- Crystal Creek Lodge
- James Day
- Amanda Leigh Dean
- Mary K Delong
- Stacia Lee Deshon
- Mary Cecilia Desrosier
- Dialysis Clinic Inc.
- Ellen-Sue Diamant
- Robert Drewelow
All providers in Browning, MT · Addiction (Substance Use Disorder) Counselor in Montana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 27, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.