Provider Demographics
NPI:1396020475
Name:SELISKAR, KATRYN BEATRICE (LCPC)
Entity Type:Individual
Prefix:
First Name:KATRYN
Middle Name:BEATRICE
Last Name:SELISKAR
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 1:2291 GRIZZLY GULCH DR
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-6653
Mailing Address - Country:US
Mailing Address - Phone:406-459-6765
Mailing Address - Fax:
Practice Address - Street 1:2291 GRIZZLY GULCH DR
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-6653
Practice Address - Country:US
Practice Address - Phone:406-459-6765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-20
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1051101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0000747170OtherBLUE CROSS-SHIELD OF MONTANA