Provider Demographics
NPI:1457771230
Name:KINGERY, CHAD (PCLC, LAC)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:
Last Name:KINGERY
Suffix:
Gender:M
Credentials:PCLC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 2ND AVENUE WEST N STE 101
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-3910
Mailing Address - Country:US
Mailing Address - Phone:406-756-6453
Mailing Address - Fax:406-756-8546
Practice Address - Street 1:285 2ND AVE WN
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-3095
Practice Address - Country:US
Practice Address - Phone:406-890-2570
Practice Address - Fax:406-314-6186
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-21
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTLAC-LIC-3401101YA0400X
MTBBH-PCLC-LIC-25856101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health