Provider Demographics
NPI:1518021112
Name:PLATT, SUSAN W (MA LCPC)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:W
Last Name:PLATT
Suffix:
Gender:F
Credentials:MA LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 W KAGY BLVD
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-6000
Mailing Address - Country:US
Mailing Address - Phone:406-587-7468
Mailing Address - Fax:406-587-4520
Practice Address - Street 1:121 W KAGY BLVD
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-6000
Practice Address - Country:US
Practice Address - Phone:406-587-7468
Practice Address - Fax:406-587-4520
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT12101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0250289Medicaid