Most Relevant Information
Provider Data
| NPI Number: | 1003683202 |
| Provider Name: | RAYMOND ROBERT ANTONSEN MS, LAC |
| Entity Type: | Individual |
| Taxonomy Code: | 101YA0400X |
| Specialty: | Counselor |
| License Number: | BBH-LAC-LIC-5017 |
Most Important Dates
| Enumeration Date: | 12/07/2023 |
| Last Updated: | 01/02/2024 |
Provider Practice Location
20 OTHALA LN
CHOTEAU
MT
594229031
Practice Location Phone/Fax
| Phone: | 4064662591 |
| Fax: |
Provider Mailing Location
PO BOX 477
CHOTEAU
MT
594220477
Provider Mailing Phone/Fax
| Phone: | 4064662591 |
| Fax: |