Healthcare Provider Details

I. General information

NPI: 1780257717
Provider Name (Legal Business Name): TAMMIE SUE SMITH LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS TAMMIE SUE SHELTON

II. Dates (important events)

Enumeration Date: 07/19/2021
Last Update Date: 09/29/2023
Certification Date: 09/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 1ST AVE N
FAIRFIELD MT
59436-9245
US

IV. Provider business mailing address

PO BOX 907
FAIRFIELD MT
59436-0907
US

V. Phone/Fax

Practice location:
  • Phone: 406-467-3447
  • Fax: 406-467-3407
Mailing address:
  • Phone: 406-799-2711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberBBH-LCPC-LIC-43683
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberBBH-LCPC-LIC-43683
License Number StateMT
# 3
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number83382
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: