Healthcare Provider Details

I. General information

NPI: 1831461722
Provider Name (Legal Business Name): LORRI COULTER M.S., S.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2012
Last Update Date: 02/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1359 E SNOW CREEK RD
BRUSETT MT
59318-9623
US

IV. Provider business mailing address

1359 E SNOW CREEK RD
BRUSETT MT
59318-9623
US

V. Phone/Fax

Practice location:
  • Phone: 406-951-2275
  • Fax: 406-557-2229
Mailing address:
  • Phone: 406-951-2275
  • Fax: 406-557-2229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number72541
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: