Healthcare Provider Details

I. General information

NPI: 1568712925
Provider Name (Legal Business Name): MARK WILLIAMS WESTON LCPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2012
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

723 5TH AVE E
KALISPELL MT
59901-5321
US

IV. Provider business mailing address

723 5TH AVE E
KALISPELL MT
59901-5321
US

V. Phone/Fax

Practice location:
  • Phone: 406-249-5506
  • Fax: 406-890-6842
Mailing address:
  • Phone: 406-249-5506
  • Fax: 406-890-6842

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number20196
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberBBH.LCPC.LIC.50271
License Number StateMT
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0003004
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: