Provider Demographics
NPI:1902522394
Name:CURETON, ELIJAH (PCLC)
Entity Type:Individual
Prefix:
First Name:ELIJAH
Middle Name:
Last Name:CURETON
Suffix:
Gender:M
Credentials:PCLC
Other - Prefix:
Other - First Name:ELI
Other - Middle Name:
Other - Last Name:CURETON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PCLC
Mailing Address - Street 1:1317 W ALDERSON ST
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-4235
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1716 W MAIN ST STE 8
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-6821
Practice Address - Country:US
Practice Address - Phone:406-414-7509
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-17
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT49241101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health