Provider Demographics
NPI:1043936313
Name:CRTALIC, ASHLEY (PCLC)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:CRTALIC
Suffix:
Gender:F
Credentials:PCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1238 CORTEZ AVE
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59105-5442
Mailing Address - Country:US
Mailing Address - Phone:406-861-4684
Mailing Address - Fax:
Practice Address - Street 1:2110 OVERLAND AVE STE 108
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-6440
Practice Address - Country:US
Practice Address - Phone:406-861-4684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-18
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-PCLC-LIC-57583101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor