Provider Demographics
NPI:1134849656
Name:HUYCK, MICHELLE LYNN (PCLC)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LYNN
Last Name:HUYCK
Suffix:
Gender:F
Credentials:PCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 EXPO PKWY APT 113
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59808-8781
Mailing Address - Country:US
Mailing Address - Phone:720-854-4114
Mailing Address - Fax:
Practice Address - Street 1:2246 BOOT HILL CT STE 4
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-7213
Practice Address - Country:US
Practice Address - Phone:406-285-1730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-02
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT56971101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health