Provider Demographics
NPI:1295183952
Name:MATHIAS, ANGELIA RAE (LCPC, LAC)
Entity Type:Individual
Prefix:
First Name:ANGELIA
Middle Name:RAE
Last Name:MATHIAS
Suffix:
Gender:F
Credentials:LCPC, LAC
Other - Prefix:
Other - First Name:ANGELIA
Other - Middle Name:R
Other - Last Name:CANTWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCPC, LAC
Mailing Address - Street 1:664 S DAKOTA ST
Mailing Address - Street 2:
Mailing Address - City:BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59701-2526
Mailing Address - Country:US
Mailing Address - Phone:406-498-9640
Mailing Address - Fax:
Practice Address - Street 1:119200 BATTLE RIDGE RD
Practice Address - Street 2:
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59750-9734
Practice Address - Country:US
Practice Address - Phone:406-498-9640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-02
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTLAC-LAC-LIC-3378101YA0400X
MECC6870101YP2500X
MTBBH-LCPC-LIC-46912101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)