Provider Demographics
NPI:1487911541
Name:EDGERTON, DUSTIN WILLIAM (LMFT)
Entity type:Individual
Prefix:MR
First Name:DUSTIN
Middle Name:WILLIAM
Last Name:EDGERTON
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:DUSTY
Other - Middle Name:WILLIAM
Other - Last Name:EDGERTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMFT
Mailing Address - Street 1:41 GRANDVIEW LOOP
Mailing Address - Street 2:
Mailing Address - City:TOWNSEND
Mailing Address - State:MT
Mailing Address - Zip Code:59644-9550
Mailing Address - Country:US
Mailing Address - Phone:406-461-6750
Mailing Address - Fax:
Practice Address - Street 1:2620 COLONIAL DR
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-4998
Practice Address - Country:US
Practice Address - Phone:406-443-1660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-13
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5856229-3902106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist