Individual
PATTY E DEROSA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCPC
Contact information
Practice address
601 14TH ST., HAVRE, MT 59501-5333
(406) 265-9671
(406) 265-8460
Mailing address
PO BOX 1609, HAVRE, MT 59501-1609
(406) 265-4296
(406) 494-1724
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
962
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
962
STATE OF MONTANA LICENSE
MT
Enumeration date
07/30/2007
Last updated
07/30/2007
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