MEDICARE: PHILLENE WHITEMAN LAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	BBHLACLIC32706	MT
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	BBH-LAC-LIC-32706	MT

General Provider Information

NPI Number	:	1831736032
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHILLENE WHITEMAN LAC

Provider Business Mailing Address
First Line	:	208 N BROADWAY STE 313946
Second Line	:
City	:	BILLINGS
State	:	MT
Zip	:	59101-3988
Country	:	US
Telephone Number	:	406-861-6673
Fax Number	:

Provider Business Practice Location Address
First Line	:	208 N BROADWAY STE 313
Second Line	:
City	:	BILLINGS
State	:	MT
Zip	:	59101-1942
Country	:	US
Telephone Number	:	406-861-6673
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/06/2019
Last Update Date	:	07/03/2025

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