| Doctor Name: | ELIZABETH CHARLAT |
| NPI Number: | 1205188075 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | SWP-LCSW-LIC-10759 |
| Business Practice Address: | 203 Main Street Polson, MT - 59860 |
| Business Phone Number: | 4068834061 |
| Business Fax Number: | |
| Mailing Address: | 1208 East 986 South, SALT LAKE CITY |
| State: | UT |
| Postal Code: | 841081222 |
| Phone Number: | 8017101970 |
| Fax Number: | |
| NPI Enumeration Date: | 10/03/2012 |
| NPI Last Update Date: | 12/30/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | SWP-LCSW-LIC-10759 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MT |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |