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General NPI Number Information
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NPI Number | 1760271399
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Entity Type | Individual
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Provider Name | REBECCA KAYE MALLOTT LAC
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Gender | Female
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Dates
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Enumeration Date | 05/01/2025
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Last Update Date | 05/01/2025
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Provider Practice Location Address
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Address Line | 1726 LAMPMAN DR
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City | BILLINGS
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State | MT
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Zip | 59102-6494
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Country | US
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Telephone | 406-545-5106
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Fax |
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Provider Business Mailing Address
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Address Line | 845 AVENUE D APT 6
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City | BILLINGS
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State | MT
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Zip | 59102-3434
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Country | US
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Telephone | 713-542-0816
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | BBH-LAC-LIC-4852
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License Number State | MT
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