Provider Demographics
NPI:1831135359
Name:EHRMANTRAUT, PAULA LYNN (MS MED LCPC CSP)
Entity Type:Individual
Prefix:MS
First Name:PAULA
Middle Name:LYNN
Last Name:EHRMANTRAUT
Suffix:
Gender:F
Credentials:MS MED LCPC CSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2509 WINDMILL DR APT 610
Mailing Address - Street 2:
Mailing Address - City:SPEARFISH
Mailing Address - State:SD
Mailing Address - Zip Code:57783-9609
Mailing Address - Country:US
Mailing Address - Phone:406-853-6020
Mailing Address - Fax:
Practice Address - Street 1:519 MAIN ST
Practice Address - Street 2:
Practice Address - City:MILES CITY
Practice Address - State:MT
Practice Address - Zip Code:59301-3037
Practice Address - Country:US
Practice Address - Phone:406-853-6020
Practice Address - Fax:406-234-5485
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-22
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY1060 LPC101YM0800X
MT0508-081970 CHT174400000X
MT00085329 CRC225C00000X
MT1196 LCPC101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No174400000XOther Service ProvidersSpecialist
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0256906Medicaid