Provider Demographics
NPI:1437711546
Name:FITZPATRICK, MALISA (LCPC, LAC)
Entity Type:Individual
Prefix:
First Name:MALISA
Middle Name:
Last Name:FITZPATRICK
Suffix:
Gender:F
Credentials:LCPC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 1ST AVE N STE 215
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59101-2630
Mailing Address - Country:US
Mailing Address - Phone:406-390-0203
Mailing Address - Fax:
Practice Address - Street 1:1140 1ST AVE N STE 215
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-2630
Practice Address - Country:US
Practice Address - Phone:406-390-3444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-28
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LAC-LIC-37252101YA0400X
MT101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)