Provider Demographics
NPI:1972704625
Name:KOLTZ, REBECCA L (PHD, LCPC, NCC)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:L
Last Name:KOLTZ
Suffix:
Gender:F
Credentials:PHD, LCPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:438 WOODMAN DR
Mailing Address - Street 2:
Mailing Address - City:BELGRADE
Mailing Address - State:MT
Mailing Address - Zip Code:59714-7243
Mailing Address - Country:US
Mailing Address - Phone:406-580-4452
Mailing Address - Fax:406-582-5717
Practice Address - Street 1:714 STONERIDGE DR
Practice Address - Street 2:SUITE 2
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-7046
Practice Address - Country:US
Practice Address - Phone:406-580-4452
Practice Address - Fax:406-582-5717
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC3753101YM0800X
MT1481 - LCPC101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health