Provider Demographics
NPI:1912197963
Name:DAVIS, KATHLEEN (LCPC)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:DAVIS
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:PO BOX 458
Mailing Address - Street 2:
Mailing Address - City:WHITEHALL
Mailing Address - State:MT
Mailing Address - Zip Code:59759-0458
Mailing Address - Country:US
Mailing Address - Phone:406-287-3062
Mailing Address - Fax:406-782-5037
Practice Address - Street 1:305 W MERCURY ST
Practice Address - Street 2:SUITE 103
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-1659
Practice Address - Country:US
Practice Address - Phone:406-782-2830
Practice Address - Fax:406-782-5037
Is Sole Proprietor?:No
Enumeration Date:2007-07-26
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1035101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1035OtherSTATE OF MONTANA LICENSE