Provider Demographics
NPI:1053537456
Name:ROO, JANET (LCPC)
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:
Last Name:ROO
Suffix:
Gender:F
Credentials:LCPC
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 2047
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:MT
Mailing Address - Zip Code:59917-2047
Mailing Address - Country:US
Mailing Address - Phone:406-197-2913
Mailing Address - Fax:
Practice Address - Street 1:818 HIGHWAY 93 N.
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:MT
Practice Address - Zip Code:59917-2047
Practice Address - Country:US
Practice Address - Phone:406-297-2913
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT769101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0253555Medicaid
MT0253555Medicare ID - Type Unspecified