Provider Demographics
NPI:1538332838
Name:ROBERT BAKKO D MIN LCPC PC
Entity Type:Organization
Organization Name:ROBERT BAKKO D MIN LCPC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKKO
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:406-259-6161
Mailing Address - Street 1:1004 DIVISION ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59101-6030
Mailing Address - Country:US
Mailing Address - Phone:406-259-6161
Mailing Address - Fax:406-294-0967
Practice Address - Street 1:1004 DIVISION ST
Practice Address - Street 2:SUITE 200
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-6030
Practice Address - Country:US
Practice Address - Phone:406-259-6161
Practice Address - Fax:406-294-0967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-08
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT17 LCPC101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0252756Medicaid
MT75010OtherBCBS