Provider Demographics
NPI:1689798753
Name:CRISSMAN, PHILIP H (MA, LCPC)
Entity Type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:H
Last Name:CRISSMAN
Suffix:
Gender:M
Credentials:MA, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 1ST AVE E
Mailing Address - Street 2:SUITE 21
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-4978
Mailing Address - Country:US
Mailing Address - Phone:406-756-6815
Mailing Address - Fax:
Practice Address - Street 1:307 1ST AVE E
Practice Address - Street 2:SUITE 21
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-4978
Practice Address - Country:US
Practice Address - Phone:406-756-6815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT293101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health