Provider Demographics
NPI:1154503134
Name:NEWELL WYATT, CHRISTINA K (LCSW, LCAS, CCS)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:K
Last Name:NEWELL WYATT
Suffix:
Gender:F
Credentials:LCSW, LCAS, CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1382
Mailing Address - Street 2:
Mailing Address - City:POLSON
Mailing Address - State:MT
Mailing Address - Zip Code:59860-1382
Mailing Address - Country:US
Mailing Address - Phone:406-210-0035
Mailing Address - Fax:406-635-8695
Practice Address - Street 1:302 1ST ST W STE 104
Practice Address - Street 2:
Practice Address - City:POLSON
Practice Address - State:MT
Practice Address - Zip Code:59860-2602
Practice Address - Country:US
Practice Address - Phone:406-210-0035
Practice Address - Fax:406-635-8695
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-30
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NCC0063251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMH0150Medicaid