Provider Demographics
NPI:1346095197
Name:GOODNIGHT, CRISTIE DEE (PCLC)
Entity Type:Individual
Prefix:
First Name:CRISTIE
Middle Name:DEE
Last Name:GOODNIGHT
Suffix:
Gender:F
Credentials:PCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 N 10TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:MT
Mailing Address - Zip Code:59840-2324
Mailing Address - Country:US
Mailing Address - Phone:406-532-9143
Mailing Address - Fax:406-363-4498
Practice Address - Street 1:209 N 10TH ST STE A
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:MT
Practice Address - Zip Code:59840-2324
Practice Address - Country:US
Practice Address - Phone:406-532-9143
Practice Address - Fax:406-363-4498
Is Sole Proprietor?:No
Enumeration Date:2024-04-23
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-PCLC-LIC-70643101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health