Provider Demographics
NPI:1134641640
Name:MICHELLE MOLES LCSW LAC
Entity Type:Organization
Organization Name:MICHELLE MOLES LCSW LAC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:R
Authorized Official - Last Name:MOLES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, LAC
Authorized Official - Phone:406-529-3629
Mailing Address - Street 1:101 E BROADWAY ST STE 602
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802-4594
Mailing Address - Country:US
Mailing Address - Phone:406-529-9362
Mailing Address - Fax:
Practice Address - Street 1:101 E BROADWAY ST STE 602
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-4594
Practice Address - Country:US
Practice Address - Phone:406-529-9362
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT16133251S00000X
MT1252251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health