Provider Demographics
NPI:1063544609
Name:CARDNEAUX, CATHY
Entity type:Individual
Prefix:
First Name:CATHY
Middle Name:
Last Name:CARDNEAUX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2139 BROADWATER AVE
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-4761
Mailing Address - Country:US
Mailing Address - Phone:406-652-7752
Mailing Address - Fax:406-652-7031
Practice Address - Street 1:2139 BROADWATER AVE
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-4761
Practice Address - Country:US
Practice Address - Phone:406-652-7752
Practice Address - Fax:406-652-7031
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT836101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0250308Medicaid
MT75078OtherBCBS PROVIDER NUMBER