Provider Demographics
NPI:1881885382
Name:WILLIAM L. SUDA, PH.D., P.C.
Entity type:Organization
Organization Name:WILLIAM L. SUDA, PH.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:LEROY
Authorized Official - Last Name:SUDA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:406-363-2266
Mailing Address - Street 1:1201 WESTWOOD DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:HAMILTON
Mailing Address - State:MT
Mailing Address - Zip Code:59840-2305
Mailing Address - Country:US
Mailing Address - Phone:406-363-2266
Mailing Address - Fax:406-363-2266
Practice Address - Street 1:1201 WESTWOOD DR
Practice Address - Street 2:SUITE C
Practice Address - City:HAMILTON
Practice Address - State:MT
Practice Address - Zip Code:59840-2305
Practice Address - Country:US
Practice Address - Phone:406-363-2266
Practice Address - Fax:406-363-2266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-08
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT89103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT51550OtherBLUE CROSS OF MONTANA
MT49-1244Medicaid
MT163709OtherMENTAL HEALTH NETWORK