Healthcare Provider Details

I. General information

NPI: 1174704225
Provider Name (Legal Business Name): NICOLE DANIELLE HUTCHERSON LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2007
Last Update Date: 05/22/2023
Certification Date: 05/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

248 1ST. AVE. W. #2380
KALISPELL MT
59903-2380
US

IV. Provider business mailing address

PO BOX 2380
KALISPELL MT
59903-2380
US

V. Phone/Fax

Practice location:
  • Phone: 406-407-8923
  • Fax:
Mailing address:
  • Phone: 406-407-8923
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: