Provider Demographics
NPI:1689865222
Name:VALLIE, MICHELLE QUARTA (LCPC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:QUARTA
Last Name:VALLIE
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:QUARTA
Other - Last Name:MALONEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 3126 26 4TH ST N
Mailing Address - Street 2:GATEWAY COMMUNITY SERVICES
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59401
Mailing Address - Country:US
Mailing Address - Phone:406-727-2512
Mailing Address - Fax:406-727-7451
Practice Address - Street 1:26 4TH ST. N.
Practice Address - Street 2:GATEWAY COMMUNITY SERVICES
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59401
Practice Address - Country:US
Practice Address - Phone:406-727-2512
Practice Address - Fax:406-727-7451
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-08
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT940 LCPC101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0000744100OtherBLUE CROSS-SHIELD OF MONT