Healthcare Provider Details

I. General information

NPI: 1588695860
Provider Name (Legal Business Name): HEIDI M. MATLACK LCSW, LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: HEIDI M. MATLACK LCSW, LAC

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 03/05/2024
Certification Date: 03/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

465 E GALENA ST STE B
BUTTE MT
59701-1931
US

IV. Provider business mailing address

465 E GALENA ST STE B
BUTTE MT
59701-1931
US

V. Phone/Fax

Practice location:
  • Phone: 406-782-0008
  • Fax:
Mailing address:
  • Phone: 406-782-0008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: