Provider Demographics
NPI:1720435563
Name:WIED, ELLEN (LCPC)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:WIED
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 1:245 2ND ST W
Mailing Address - Street 2:
Mailing Address - City:WHITEFISH
Mailing Address - State:MT
Mailing Address - Zip Code:59937-3006
Mailing Address - Country:US
Mailing Address - Phone:406-662-1771
Mailing Address - Fax:
Practice Address - Street 1:245 2ND ST W
Practice Address - Street 2:
Practice Address - City:WHITEFISH
Practice Address - State:MT
Practice Address - Zip Code:59937-3006
Practice Address - Country:US
Practice Address - Phone:406-662-1771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-23
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT64528101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional