Provider Demographics
NPI:1285646133
Name:DILTS, CONNIE (LCPC, LMFT)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:
Last Name:DILTS
Suffix:
Gender:F
Credentials:LCPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 WYOMING AVE
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59101-1637
Mailing Address - Country:US
Mailing Address - Phone:406-254-8604
Mailing Address - Fax:406-294-0967
Practice Address - Street 1:902 WYOMING AVE
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-1637
Practice Address - Country:US
Practice Address - Phone:406-254-8604
Practice Address - Fax:406-294-0967
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT489LCPC101YM0800X
MT126106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT000074965OtherBCBS
MT0254046Medicaid