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CHARLES M RIPLEY LAC

Addiction Substance Use Disorder

Polson, Montana

Provider NPI: 1184655045

Provider Information:
 CHARLES M RIPLEY LAC
Gender: M
Not Sole Proprietor

Practice Location:
802 MAIN ST STE C  POLSON, MT 59860 US
Tel: 406-883-7310  Fax: 406-883-7312

Business Mailing Address:
802 MAIN ST STE C  POLSON, MT 59860 US
Tel: 406-883-7310  Fax: 406-883-7312

Entity Type: Individual

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
Y101YA0400XBehavioral Health & Social Service Providers
Counselor
Addiction (Substance Use Disorder)
MT886

Other Provider Identifiers:

IssuerNumberStateType
0320099MT05
BLUE CROSS BLUE SHIELD760690MT01
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin







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