Provider Demographics
NPI:1477867364
Name:SOULE, TIMOTHY HARTMAN (LCSW)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:HARTMAN
Last Name:SOULE
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 1:20 3RD ST E
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-4573
Mailing Address - Country:US
Mailing Address - Phone:406-755-9471
Mailing Address - Fax:406-756-8113
Practice Address - Street 1:205 E PARK AVE
Practice Address - Street 2:
Practice Address - City:ANACONDA
Practice Address - State:MT
Practice Address - Zip Code:59711-2340
Practice Address - Country:US
Practice Address - Phone:406-563-8117
Practice Address - Fax:406-563-5956
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-03
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT9031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical