Provider Demographics
NPI:1942345426
Name:MIQUELLE, DANA BRYER (MA LCPC)
Entity Type:Individual
Prefix:MR
First Name:DANA
Middle Name:BRYER
Last Name:MIQUELLE
Suffix:
Gender:M
Credentials:MA LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 E MAIN
Mailing Address - Street 2:405
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715
Mailing Address - Country:US
Mailing Address - Phone:406-587-8775
Mailing Address - Fax:406-587-8775
Practice Address - Street 1:321 E MAIN
Practice Address - Street 2:SUITE 405
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715
Practice Address - Country:US
Practice Address - Phone:406-587-8775
Practice Address - Fax:406-587-8775
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT883LCPC103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0000252416Medicaid
MT740423OtherBCBS