Provider Demographics
NPI:1972697894
Name:SETTEVENDEMIE, MICHAEL (PSYD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:SETTEVENDEMIE
Suffix:
Gender:M
Credentials:PSYD
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 3138
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59806-3138
Mailing Address - Country:US
Mailing Address - Phone:406-541-8887
Mailing Address - Fax:
Practice Address - Street 1:415 N HIGGINS AVE
Practice Address - Street 2:STE 111A
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-4522
Practice Address - Country:US
Practice Address - Phone:406-541-8887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT767103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0256904Medicaid
MTOTH000Medicare UPIN