Provider Demographics
NPI:1811557424
Name:MESTAS, MICHAEL CORY (MS PCLC, NCC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:CORY
Last Name:MESTAS
Suffix:
Gender:M
Credentials:MS PCLC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 YELLOWSTONE AVE
Mailing Address - Street 2:
Mailing Address - City:BELGRADE
Mailing Address - State:MT
Mailing Address - Zip Code:59714-4240
Mailing Address - Country:US
Mailing Address - Phone:406-539-2905
Mailing Address - Fax:
Practice Address - Street 1:324 EAST MAIN ST.
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:MT
Practice Address - Zip Code:59741
Practice Address - Country:US
Practice Address - Phone:406-945-3122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-17
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-PCLC-LIC-31411101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty