Provider Demographics
NPI:1629434485
Name:NICKLAY, CHRISTINE MICHELE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:MICHELE
Last Name:NICKLAY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CHRIS
Other - Middle Name:
Other - Last Name:PILGRIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 17159
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59808-7159
Mailing Address - Country:US
Mailing Address - Phone:406-529-2609
Mailing Address - Fax:406-258-0656
Practice Address - Street 1:2200 GREAT NORTHERN AVE APT G31
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59808-1650
Practice Address - Country:US
Practice Address - Phone:406-529-2609
Practice Address - Fax:406-258-0656
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-10
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT150121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical