Provider Demographics
NPI:1871036046
Name:O'TOOL, TANIQUELL WILDER (LCPC)
Entity Type:Individual
Prefix:
First Name:TANIQUELL
Middle Name:WILDER
Last Name:O'TOOL
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 N 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-3310
Mailing Address - Country:US
Mailing Address - Phone:406-589-5309
Mailing Address - Fax:
Practice Address - Street 1:416 N 7TH AVE
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-3310
Practice Address - Country:US
Practice Address - Phone:406-209-8644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-21
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LCPC-LIC-23182101Y00000X
MT23182101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor