Individual
RAYMOND ROBERT ANTONSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS, LAC
Contact information
Practice address
20 OTHALA LN, CHOTEAU, MT 59422-9031
(406) 466-2591
Mailing address
PO BOX 477, CHOTEAU, MT 59422-0477
(406) 466-2591
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
BBH-LAC-LIC-5017
MT
Other
Enumeration date
12/07/2023
Last updated
01/02/2024
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