Provider Demographics
NPI:1932671104
Name:QUINN, PHILLIP MONTGOMERY (LCPC)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:MONTGOMERY
Last Name:QUINN
Suffix:
Gender:M
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 907
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59624-0907
Mailing Address - Country:US
Mailing Address - Phone:406-461-5227
Mailing Address - Fax:
Practice Address - Street 1:515 N EWING ST STE 107
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-4002
Practice Address - Country:US
Practice Address - Phone:406-442-4130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-27
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LCPC-LIC-35321101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTBBH-LCPC-LIC-35321OtherBUSINESS STANDARDS DIVISION, BOARD OF BEHAVIORAL HEALTH