Provider Demographics
NPI:1215781083
Name:MATT, CARMELITA ANN (MSW, SWLC)
Entity type:Individual
Prefix:
First Name:CARMELITA
Middle Name:ANN
Last Name:MATT
Suffix:
Gender:F
Credentials:MSW, SWLC
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 1144
Mailing Address - Street 2:
Mailing Address - City:ST IGNATIUS
Mailing Address - State:MT
Mailing Address - Zip Code:59865-1144
Mailing Address - Country:US
Mailing Address - Phone:406-214-1426
Mailing Address - Fax:
Practice Address - Street 1:1724 FAIRVIEW AVE STE A
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-7873
Practice Address - Country:US
Practice Address - Phone:406-214-3810
Practice Address - Fax:406-720-7806
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-16
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-SWLC-LIC-704961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty