Provider Demographics
NPI:1588675326
Name:PITTACK, MICHELLE (LCPC)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:
Last Name:PITTACK
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 20897
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59104-0897
Mailing Address - Country:US
Mailing Address - Phone:406-255-0209
Mailing Address - Fax:406-294-0967
Practice Address - Street 1:1643 LEWIS AVE
Practice Address - Street 2:SUITE #4
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-4151
Practice Address - Country:US
Practice Address - Phone:406-255-0209
Practice Address - Fax:406-294-0967
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2009-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT797LCPC101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0252773Medicaid
MT000075458OtherBCBS