Provider Demographics
NPI:1245604636
Name:DICKMAN, KATIE (LCPC)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:DICKMAN
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:PO BOX 1643
Mailing Address - Street 2:1732 SOUTH 72ND STREET W
Mailing Address - City:RED LODGE
Mailing Address - State:MT
Mailing Address - Zip Code:59068
Mailing Address - Country:US
Mailing Address - Phone:406-655-2138
Mailing Address - Fax:
Practice Address - Street 1:1732 S 72ND ST W
Practice Address - Street 2:1732 SOUTH 72ND STREET W
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59106-3538
Practice Address - Country:US
Practice Address - Phone:406-655-2138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-23
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LCSW-LIC-13215101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health