Healthcare Provider Details

I. General information

NPI: 1912020249
Provider Name (Legal Business Name): MICHAEL JOHN MCLAUGHLIN PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 1ST AVE S CENTER FOR MENTAL HEALTH
GREAT FALLS MT
59401-3705
US

IV. Provider business mailing address

2506 1ST AVE N
GREAT FALLS MT
59401-3324
US

V. Phone/Fax

Practice location:
  • Phone: 406-791-9603
  • Fax: 406-761-0554
Mailing address:
  • Phone: 406-453-7251
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number132
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: