Healthcare Provider Details

I. General information

NPI: 1831736032
Provider Name (Legal Business Name): PHILLENE WHITEMAN LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2019
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1223 N CENTER AVE
HARDIN MT
59034-1100
US

IV. Provider business mailing address

1223 N CENTER AVE
HARDIN MT
59034-1100
US

V. Phone/Fax

Practice location:
  • Phone: 406-665-4103
  • Fax:
Mailing address:
  • Phone: 406-665-4103
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberBBHLACLIC32706
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberBBH-LAC-LIC-32706
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: