Provider Demographics
NPI:1023473394
Name:WALDMANN, KIM (LCPC)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:WALDMANN
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 50186
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59105-0186
Mailing Address - Country:US
Mailing Address - Phone:406-371-3399
Mailing Address - Fax:
Practice Address - Street 1:1220 AVENUE C
Practice Address - Street 2:STE C
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-3200
Practice Address - Country:US
Practice Address - Phone:406-371-3399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-30
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT15795101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional