Provider Demographics
NPI:1366512766
Name:FELTEN, GWEN (LCPC)
Entity type:Individual
Prefix:
First Name:GWEN
Middle Name:
Last Name:FELTEN
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 1:1004 DIVISION ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59101-6030
Mailing Address - Country:US
Mailing Address - Phone:406-259-6161
Mailing Address - Fax:406-294-0967
Practice Address - Street 1:1004 DIVISION ST
Practice Address - Street 2:SUITE 200
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-6030
Practice Address - Country:US
Practice Address - Phone:406-259-6161
Practice Address - Fax:406-294-0967
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT831LCPC101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0252807Medicaid