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General NPI Number Information
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NPI Number | 1003657131
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Entity Type | Organization
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Legal Business Name | STACEY DE WITT LCPC LLC (STACEY M DE WITT SOLE MBR)
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Dates
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Enumeration Date | 06/03/2024
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Last Update Date | 06/03/2024
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Provider Practice Location Address
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Address Line | 725 W ALDER ST STE 10
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City | MISSOULA
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State | MT
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Zip | 59802-4099
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Country | US
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Telephone | 406-529-5121
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 134
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City | LOLO
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State | MT
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Zip | 59847-0134
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Country | US
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Telephone | 406-529-5121
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Fax |
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | STACEY M DE WITT
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Credential | LCPC
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Telephone | 406-529-5121
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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