Provider Demographics
NPI:1548029515
Name:DORCHEUS, HOLLY MARIE (ACLC)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:MARIE
Last Name:DORCHEUS
Suffix:
Gender:F
Credentials:ACLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:HAVRE
Mailing Address - State:MT
Mailing Address - Zip Code:59501-3917
Mailing Address - Country:US
Mailing Address - Phone:406-399-1757
Mailing Address - Fax:
Practice Address - Street 1:605 3RD AVE
Practice Address - Street 2:
Practice Address - City:HAVRE
Practice Address - State:MT
Practice Address - Zip Code:59501-3917
Practice Address - Country:US
Practice Address - Phone:406-399-1757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-13
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-ACLC-LIC-65530101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)