Provider Demographics
NPI:1013986348
Name:EMERSON, MICHAEL A (PHD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:A
Last Name:EMERSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 FRIENDSHIP LN
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MONTANA CITY
Mailing Address - State:MT
Mailing Address - Zip Code:59634-9804
Mailing Address - Country:US
Mailing Address - Phone:406-495-0956
Mailing Address - Fax:406-442-8090
Practice Address - Street 1:11 FRIENDSHIP LN
Practice Address - Street 2:SUITE 202
Practice Address - City:MONTANA CITY
Practice Address - State:MT
Practice Address - Zip Code:59634-9804
Practice Address - Country:US
Practice Address - Phone:406-495-0956
Practice Address - Fax:406-442-8090
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT470 LCPC101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT74953OtherBC/BS PROVIDER NUMBER