Provider Demographics
NPI:1588019400
Name:MAES, KATIE LYNN (LCPC)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:LYNN
Last Name:MAES
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:LYNN
Other - Last Name:EDWARDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:321 FAIRVIEW ST S
Mailing Address - Street 2:
Mailing Address - City:ANACONDA
Mailing Address - State:MT
Mailing Address - Zip Code:59711-2083
Mailing Address - Country:US
Mailing Address - Phone:406-560-6736
Mailing Address - Fax:
Practice Address - Street 1:205 CHERRY ST STE 2
Practice Address - Street 2:
Practice Address - City:ANACONDA
Practice Address - State:MT
Practice Address - Zip Code:59711-2319
Practice Address - Country:US
Practice Address - Phone:406-560-6736
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-28
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT17380101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0000000Medicaid