Provider Demographics
NPI:1962791533
Name:HODGETTS, THOMAS (LCSW)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:
Last Name:HODGETTS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 N ORANGE ST STE 102
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802-2951
Mailing Address - Country:US
Mailing Address - Phone:406-327-3034
Mailing Address - Fax:
Practice Address - Street 1:900 N ORANGE ST STE 102
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802
Practice Address - Country:US
Practice Address - Phone:406-327-3034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-04
Last Update Date:2023-01-17
Deactivation Date:2022-12-09
Deactivation Code:
Reactivation Date:2022-12-30
Provider Licenses
StateLicense IDTaxonomies
MT9961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical