Healthcare Provider Details

I. General information

NPI: 1285404202
Provider Name (Legal Business Name): MADISON TREYLIN KOTERBA LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2024
Last Update Date: 02/04/2025
Certification Date: 02/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4430 ALTAY DR UNIT 313
BILLINGS MT
59106-2885
US

IV. Provider business mailing address

PO BOX 80062
BILLINGS MT
59108-0062
US

V. Phone/Fax

Practice location:
  • Phone: 406-366-9883
  • Fax:
Mailing address:
  • Phone: 406-366-9883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number64788
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: