Provider Demographics
NPI:1861081200
Name:NEWBY, KATE KELLEY (LCPC)
Entity type:Individual
Prefix:
First Name:KATE
Middle Name:KELLEY
Last Name:NEWBY
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 17832
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59808-7832
Mailing Address - Country:US
Mailing Address - Phone:650-207-0123
Mailing Address - Fax:
Practice Address - Street 1:2616 MUIRFIELD CT
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59808-9472
Practice Address - Country:US
Practice Address - Phone:650-207-0123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-11
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-PCLC-LIC-45189101YM0800X
MTBBH-LCPC-LIC-65953101YM0800X
MT65953101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTBBH-LCPC-LIC-65953OtherBBH LICENSE NUMBER