Provider Demographics
NPI:1144603895
Name:PICKENS, SUSAN SARGENT (LCPC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:SARGENT
Last Name:PICKENS
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 1:2012 SWANSON LN
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-7549
Mailing Address - Country:US
Mailing Address - Phone:406-698-8508
Mailing Address - Fax:
Practice Address - Street 1:2012 SWANSON LN
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-7549
Practice Address - Country:US
Practice Address - Phone:406-698-8508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-30
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTLCPC-LIC-19620101YM0800X
MTLAC-LAC-LIC-4511101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)