Healthcare Provider Details

I. General information

NPI: 1851116396
Provider Name (Legal Business Name): KATIE DEFELICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2024
Last Update Date: 09/24/2025
Certification Date: 09/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 MARCUS ST 3RD FLOOR, SUITE 1E
HAMILTON MT
59840-3360
US

IV. Provider business mailing address

200 BLOOD LN
HAMILTON MT
59840-3360
US

V. Phone/Fax

Practice location:
  • Phone: 406-602-5606
  • Fax:
Mailing address:
  • Phone: 406-602-5606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: KATIE L DEFELICE
Title or Position: OWNER/OPERATOR
Credential: LCSW
Phone: 406-602-5606