Provider Demographics
NPI:1871225524
Name:WALTER, MIRI'IKAI (LCPC, LAC, MACMHC)
Entity Type:Individual
Prefix:
First Name:MIRI'IKAI
Middle Name:
Last Name:WALTER
Suffix:
Gender:F
Credentials:LCPC, LAC, MACMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 11TH AVE STE 24-27
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-4875
Mailing Address - Country:US
Mailing Address - Phone:406-607-7003
Mailing Address - Fax:406-551-1066
Practice Address - Street 1:2001 11TH AVE STE 24
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-4881
Practice Address - Country:US
Practice Address - Phone:406-919-6466
Practice Address - Fax:406-551-1066
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-29
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT63798101YA0400X
MT70513101YP2500X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1871225524Medicaid