Provider Demographics
NPI:1790291615
Name:HAUGHTON, KASSANDRA (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:KASSANDRA
Middle Name:
Last Name:HAUGHTON
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:KASSANDRA
Other - Middle Name:
Other - Last Name:GAHAGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCPC
Mailing Address - Street 1:PO BOX 423
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59771-0423
Mailing Address - Country:US
Mailing Address - Phone:406-579-7883
Mailing Address - Fax:
Practice Address - Street 1:699 FARMHOUSE LN
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715
Practice Address - Country:US
Practice Address - Phone:406-556-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-15
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LCPC-LIC-27254101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional