Healthcare Provider Details

I. General information

NPI: 1851886030
Provider Name (Legal Business Name): CODY MICHAEL PARDUE LCPC, LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2018
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 4TH ST S
GREAT FALLS MT
59401-3618
US

IV. Provider business mailing address

601 1ST AVE N
GREAT FALLS MT
59401-2510
US

V. Phone/Fax

Practice location:
  • Phone: 406-454-6973
  • Fax: 406-791-9277
Mailing address:
  • Phone: 406-454-6973
  • Fax: 406-791-9277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberBBH-LAC-LIC-23044
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberBBH-LCPC-LIC-78611
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: