Provider Demographics
NPI:1093579930
Name:FLETCHER, SUZETTE RENEE (PCLC)
Entity Type:Individual
Prefix:
First Name:SUZETTE
Middle Name:RENEE
Last Name:FLETCHER
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 1:1425 WOODLAND TRL
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59105-1928
Mailing Address - Country:US
Mailing Address - Phone:406-861-0055
Mailing Address - Fax:
Practice Address - Street 1:1425 WOODLAND TRL
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59105-1928
Practice Address - Country:US
Practice Address - Phone:406-861-0055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-12
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-PCLC-LIC-69952101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health