Provider Demographics
NPI:1265741672
Name:MATTA, ANGELA ROSE (LCSW, LAC)
Entity type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:ROSE
Last Name:MATTA
Suffix:
Gender:F
Credentials:LCSW, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3516 54TH ST W
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59106-1044
Mailing Address - Country:US
Mailing Address - Phone:406-208-8959
Mailing Address - Fax:
Practice Address - Street 1:208 N BROADWAY STE 423
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-1943
Practice Address - Country:US
Practice Address - Phone:406-896-8427
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-03
Last Update Date:2010-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1202101YA0400X
MT8741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty