Healthcare Provider Details

I. General information

NPI: 1669773602
Provider Name (Legal Business Name): LYNELLA MATTOX ANKELMAN LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2010
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 E COPPER ST
BUTTE MT
59701-9302
US

IV. Provider business mailing address

T-9 FORT MISSOULA
MISSOULA MT
59804-7202
US

V. Phone/Fax

Practice location:
  • Phone: 406-723-7104
  • Fax: 406-723-4857
Mailing address:
  • Phone: 406-532-9800
  • Fax: 406-543-9316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberBBH-LCPC-LIC-1511
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: