Provider Demographics
NPI:1003525262
Name:THOMAS HODGETTS, LCSW PLLC
Entity Type:Organization
Organization Name:THOMAS HODGETTS, LCSW PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:HODGETTS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:406-239-5279
Mailing Address - Street 1:2213 GREENOUGH CT W
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802-3582
Mailing Address - Country:US
Mailing Address - Phone:406-239-5279
Mailing Address - Fax:
Practice Address - Street 1:101 E BROADWAY ST STE 204
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-4510
Practice Address - Country:US
Practice Address - Phone:406-239-5279
Practice Address - Fax:406-578-8340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-16
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1962791533Medicaid