Provider Demographics
NPI:1336740679
Name:WOLCOTT, MICA FREELAND (LCPC)
Entity Type:Individual
Prefix:
First Name:MICA
Middle Name:FREELAND
Last Name:WOLCOTT
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 306
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MT
Mailing Address - Zip Code:59825-0306
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:19770 SWARTZ CREEK RD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MT
Practice Address - Zip Code:59825
Practice Address - Country:US
Practice Address - Phone:406-540-4120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-03
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LCPC-LIC-44386101YM0800X
ID9074101YM0800X
MT44386101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health