Provider Demographics
NPI:1003920646
Name:MAIJA, TERESA (LCPC)
Entity Type:Individual
Prefix:MS
First Name:TERESA
Middle Name:
Last Name:MAIJA
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 W MAIN ST STE 203
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:MT
Mailing Address - Zip Code:59840-2443
Mailing Address - Country:US
Mailing Address - Phone:406-837-2872
Mailing Address - Fax:
Practice Address - Street 1:310 N 4TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:HAMILTON
Practice Address - State:MT
Practice Address - Zip Code:59840-2412
Practice Address - Country:US
Practice Address - Phone:406-363-5410
Practice Address - Fax:406-363-4498
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1198-LCPC101YP2500X
MT1198101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0257295Medicaid