Provider Demographics
NPI:1902515240
Name:STANDLEY, DANIELLE IRENE (LAC)
Entity Type:Individual
Prefix:MS
First Name:DANIELLE
Middle Name:IRENE
Last Name:STANDLEY
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 S 5TH ST W
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-2618
Mailing Address - Country:US
Mailing Address - Phone:406-203-2589
Mailing Address - Fax:
Practice Address - Street 1:510 S 5TH ST W
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-2618
Practice Address - Country:US
Practice Address - Phone:406-203-2589
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-15
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LAC-PRV-57370101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTAAA0000091425OtherDRIVER'S LICENSE