Healthcare Provider Details

I. General information

NPI: 1942082284
Provider Name (Legal Business Name): MICHELLE LOUISE WETTSTEIN-PETERSON LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2023
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1102 2ND AVE S STE 3
GLASGOW MT
59230-2215
US

IV. Provider business mailing address

PO BOX 949
GLASGOW MT
59230-0949
US

V. Phone/Fax

Practice location:
  • Phone: 406-228-8225
  • Fax: 406-228-8201
Mailing address:
  • Phone: 406-228-8225
  • Fax: 406-228-8201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: