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General NPI Number Information
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NPI Number | 1366901266
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Entity Type | Individual
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Provider Name | PHILIP LODIEN
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Gender | Male
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Dates
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Enumeration Date | 03/19/2019
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Last Update Date | 03/19/2019
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Provider Practice Location Address
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Address Line | 723 5TH AVE. EAST ST. B18
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City | KALISPELL
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State | MT
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Zip | 59901-5990
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Country | US
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Telephone | 406-253-1609
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Fax |
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Provider Business Mailing Address
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Address Line | 150 CEDAR COMMONS LN APT 3
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City | KALISPELL
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State | MT
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Zip | 59901-5750
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Country | US
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Telephone | 406-270-8591
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | BBH-PCLC-LIC-37322
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License Number State | MT
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