Provider Demographics
NPI:1356092175
Name:DUKE, DUSTIN (LCPC, LAC)
Entity type:Individual
Prefix:
First Name:DUSTIN
Middle Name:
Last Name:DUKE
Suffix:
Gender:M
Credentials:LCPC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 310
Mailing Address - Street 2:
Mailing Address - City:SHEPHERD
Mailing Address - State:MT
Mailing Address - Zip Code:59079-0310
Mailing Address - Country:US
Mailing Address - Phone:406-200-4612
Mailing Address - Fax:
Practice Address - Street 1:1629 AVENUE D STE A5
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-3042
Practice Address - Country:US
Practice Address - Phone:406-200-4612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-13
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LIC-LAC-55307101YA0400X
MTBBH-LCPC-LIC-62191101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)