Healthcare Provider Details

I. General information

NPI: 1497672174
Provider Name (Legal Business Name): MICHELLE MITCHELL LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

191 JEWEL BASIN CT STE 3D
BIGFORK MT
59911-6294
US

IV. Provider business mailing address

191 JEWEL BASIN CT STE 3D
BIGFORK MT
59911-6294
US

V. Phone/Fax

Practice location:
  • Phone: 406-201-9419
  • Fax:
Mailing address:
  • Phone: 406-201-9419
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number88373
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: