Doctor Name: | KELLY ANNE EWALT |
NPI Number: | 1699081125 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCPC |
License Number: | 683 |
Business Practice Address: | 305 1st Ave W Columbia Falls, MT - 599123619 |
Business Phone Number: | 4062499153 |
Business Fax Number: | |
Mailing Address: | 770 Jensen Rd, COLUMBIA FALLS |
State: | MT |
Postal Code: | 599129164 |
Phone Number: | 4062499153 |
Fax Number: | |
NPI Enumeration Date: | 08/22/2010 |
NPI Last Update Date: | 08/22/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 683 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MT |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |