Healthcare Provider Details

I. General information

NPI: 1770016834
Provider Name (Legal Business Name): NICOLAIS CUYLE LCPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2017
Last Update Date: 03/13/2024
Certification Date: 03/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 MELISSA WAY
BELGRADE MT
59714-9390
US

IV. Provider business mailing address

PO BOX 914
BELGRADE MT
59714-0914
US

V. Phone/Fax

Practice location:
  • Phone: 406-595-6478
  • Fax:
Mailing address:
  • Phone: 406-595-6478
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberBBH-LCPC-LIC-23378
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: