Provider Demographics
NPI:1194364091
Name:PERUSICH, TOMMIE LYNN (PMHNP-BC)
Entity type:Individual
Prefix:MS
First Name:TOMMIE
Middle Name:LYNN
Last Name:PERUSICH
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2210 SILVER BOW BLVD
Mailing Address - Street 2:
Mailing Address - City:BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59701-4940
Mailing Address - Country:US
Mailing Address - Phone:406-491-9282
Mailing Address - Fax:
Practice Address - Street 1:2210 SILVER BOW BLVD
Practice Address - Street 2:
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-4940
Practice Address - Country:US
Practice Address - Phone:406-491-9282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-26
Last Update Date:2025-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT155842363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0290819Medicaid