Provider Demographics
NPI:1285404202
Name:KOTERBA, MADISON TREYLIN (LCPC)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:TREYLIN
Last Name:KOTERBA
Suffix:
Gender:F
Credentials:LCPC
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 80062
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59108-0062
Mailing Address - Country:US
Mailing Address - Phone:406-366-9883
Mailing Address - Fax:
Practice Address - Street 1:4430 ALTAY DR UNIT 313
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59106-2885
Practice Address - Country:US
Practice Address - Phone:406-366-9883
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-02
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT64788101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional