Provider Demographics
NPI:1780246637
Name:QUILICI, JANIE (LAC, LCSW)
Entity type:Individual
Prefix:
First Name:JANIE
Middle Name:
Last Name:QUILICI
Suffix:
Gender:F
Credentials:LAC, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3260 RODEO RD
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59803-9663
Mailing Address - Country:US
Mailing Address - Phone:406-239-5911
Mailing Address - Fax:406-224-4402
Practice Address - Street 1:2825 FORT MISSOULA RD STE 317
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59804-7403
Practice Address - Country:US
Practice Address - Phone:406-728-4100
Practice Address - Fax:406-532-9901
Is Sole Proprietor?:No
Enumeration Date:2019-07-01
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LAC-LIC-37623101YA0400X
MTBBH-LCSW-LIC-714241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)