Provider Demographics
NPI:1114192440
Name:CHARLES I. NEWELL
Entity Type:Organization
Organization Name:CHARLES I. NEWELL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:I
Authorized Official - Last Name:NEWELL
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:406-259-6161
Mailing Address - Street 1:PO BOX 20495
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59104-0495
Mailing Address - Country:US
Mailing Address - Phone:406-259-6161
Mailing Address - Fax:406-294-0967
Practice Address - Street 1:1004 DIVISION ST
Practice Address - Street 2:SUITE 100
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-6030
Practice Address - Country:US
Practice Address - Phone:406-259-6161
Practice Address - Fax:406-294-0967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-28
Last Update Date:2009-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1170 LCPC101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT000742090OtherBCBS
MT0256615Medicaid