Provider Demographics
NPI:1457806598
Name:NOLD, STEPHANIE (MS, LCPC)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:NOLD
Suffix:
Gender:F
Credentials:MS, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 SW HIGGINS AVE APT C
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59803-1451
Mailing Address - Country:US
Mailing Address - Phone:816-273-9495
Mailing Address - Fax:
Practice Address - Street 1:501 SW HIGGINS AVE APT C
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59803-1451
Practice Address - Country:US
Practice Address - Phone:816-273-9495
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-18
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT13580101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health