Provider Demographics
NPI:1407915879
Name:WEISS, KATE (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:KATE
Middle Name:
Last Name:WEISS
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 1:1078 MEAGHER AVE
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-7061
Mailing Address - Country:US
Mailing Address - Phone:406-223-4041
Mailing Address - Fax:
Practice Address - Street 1:1078 MEAGHER AVE
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-7061
Practice Address - Country:US
Practice Address - Phone:406-223-4041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1030101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0254524Medicaid
MT745443OtherBLUE CROSS-SHIELD OF MT