Individual
LEA M STANTON GREGOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCPC
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
1218
MT
101YP2500X
Professional Counselor
Primary
369
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
742860
BLUE CROSS PROVIDER
MT
Enumeration date
04/17/2007
Last updated
08/19/2011
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