Provider Demographics
NPI:1619156700
Name:KOHLSTAEDT, ELIZABETH VINSON (PHD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:VINSON
Last Name:KOHLSTAEDT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 S LAMBORN ST
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-5417
Mailing Address - Country:US
Mailing Address - Phone:406-457-4754
Mailing Address - Fax:406-442-7949
Practice Address - Street 1:500 S LAMBORN ST
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-5417
Practice Address - Country:US
Practice Address - Phone:406-457-4754
Practice Address - Fax:406-442-7949
Is Sole Proprietor?:No
Enumeration Date:2007-10-25
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTPSYCHOLOGIST 221103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical