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General NPI Number Information
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NPI Number | 1134641640
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Entity Type | Organization
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Legal Business Name | MICHELLE MOLES LCSW LAC
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Dates
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Enumeration Date | 07/17/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 101 E BROADWAY ST STE 602
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City | MISSOULA
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State | MT
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Zip | 59802-4594
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Country | US
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Telephone | 406-529-9362
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Fax |
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Provider Business Mailing Address
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Address Line | 101 E BROADWAY ST STE 602
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City | MISSOULA
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State | MT
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Zip | 59802-4594
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Country | US
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Telephone | 406-529-9362
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Fax |
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Authorized Official
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Title or Position | COUNSELOR
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Name | MS. MICHELLE R MOLES
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Credential | LCSW, LAC
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Telephone | 406-529-3629
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 1252
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License Number State | MT
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 16133
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License Number State | MT
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