Provider Demographics
NPI:1417079823
Name:NILE, MICHAEL J (LCSW)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:J
Last Name:NILE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 E BROADWAY ST
Mailing Address - Street 2:STE. 604
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802-4532
Mailing Address - Country:US
Mailing Address - Phone:406-396-4010
Mailing Address - Fax:
Practice Address - Street 1:101 E BROADWAY ST
Practice Address - Street 2:STE. 604
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-4532
Practice Address - Country:US
Practice Address - Phone:406-396-4010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2011-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT5881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical