Provider Demographics
NPI:1295514479
Name:MCHUTCHISON, MICHELLE (PCLC)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:MCHUTCHISON
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 1:226 S 3RD ST W APT 1
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-2773
Mailing Address - Country:US
Mailing Address - Phone:406-304-6642
Mailing Address - Fax:
Practice Address - Street 1:115 W KAGY BLVD STE O
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-6026
Practice Address - Country:US
Practice Address - Phone:406-304-6642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-26
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-PCLC-LIC-64638101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health