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Individual

MRS. EVELYN ANN O LEARY BENNETT

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
RN LCPC

Contact information

Practice address
127 N HIGGINS AVE RM 206, MISSOULA, MT 59802-4457
(406) 549-2625
Mailing address
127 N HIGGINS AVE RM 206, MISSOULA, MT 59802-4457
(406) 549-2625

Taxonomy

Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
484LCPC
MT
163WR0400X
Rehabilitation Registered Nurse
Primary
09268
MT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0253657
MT
01
13005657
MT ST FUND PAYEE
MT
01
74903
BCBS
MT
Enumeration date
11/01/2006
Last updated
09/11/2025
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