Provider Demographics
NPI:1295943710
Name:SKUNKCAP, IRMA FAYE (LAC)
Entity type:Individual
Prefix:MRS
First Name:IRMA
Middle Name:FAYE
Last Name:SKUNKCAP
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 552
Mailing Address - Street 2:
Mailing Address - City:BROWNING
Mailing Address - State:MT
Mailing Address - Zip Code:59417-0552
Mailing Address - Country:US
Mailing Address - Phone:406-338-6330
Mailing Address - Fax:
Practice Address - Street 1:656 AGENCY MAIN STREET
Practice Address - Street 2:
Practice Address - City:HARLEM
Practice Address - State:MT
Practice Address - Zip Code:59526
Practice Address - Country:US
Practice Address - Phone:406-353-4175
Practice Address - Fax:406-353-4771
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LAC-LIC-1149101YA0400X
MT1149-LAC101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)