Provider Demographics
NPI:1316691710
Name:VANDEKOP, ELLEN (LCPC)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:VANDEKOP
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 1:825 GREAT NORTHERN BLVD STE 326
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-3392
Mailing Address - Country:US
Mailing Address - Phone:406-850-6595
Mailing Address - Fax:
Practice Address - Street 1:825 GREAT NORTHERN BLVD STE 326
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-3392
Practice Address - Country:US
Practice Address - Phone:406-850-6595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-05
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X, 103TP2701X
MTBBH-LCPC-LIC-55123101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1316691710Medicaid
MTBBH-LCPC-LIC-55123OtherLICENSED CLINICAL PROFESSIONAL