Provider Demographics
NPI:1316466329
Name:ELLINGSON, SADIE RAE (LCPC)
Entity type:Individual
Prefix:
First Name:SADIE
Middle Name:RAE
Last Name:ELLINGSON
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:SADIE
Other - Middle Name:RAE
Other - Last Name:MARICICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCPC
Mailing Address - Street 1:445 CENTENNIAL AVE
Mailing Address - Street 2:
Mailing Address - City:BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59701-2870
Mailing Address - Country:US
Mailing Address - Phone:406-723-4075
Mailing Address - Fax:406-496-6035
Practice Address - Street 1:445 CENTENNIAL AVEUNUE
Practice Address - Street 2:
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-2870
Practice Address - Country:US
Practice Address - Phone:406-723-4075
Practice Address - Fax:406-723-3059
Is Sole Proprietor?:No
Enumeration Date:2017-09-12
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LCPC-LIC-25445101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional