Provider Demographics
NPI:1821475765
Name:TIA UTZINGER PLLC
Entity Type:Organization
Organization Name:TIA UTZINGER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:TIA
Authorized Official - Middle Name:EBBA
Authorized Official - Last Name:UTZINGER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:406-579-9011
Mailing Address - Street 1:PO BOX 6087
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59771-6087
Mailing Address - Country:US
Mailing Address - Phone:406-579-9011
Mailing Address - Fax:
Practice Address - Street 1:501 E PEACH ST
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-3000
Practice Address - Country:US
Practice Address - Phone:406-579-9011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-29
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT555LCSW1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty