Provider Demographics
NPI:1760271399
Name:MALLOTT, REBECCA KAYE (LAC)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:KAYE
Last Name:MALLOTT
Suffix:
Gender:
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:845 AVENUE D APT 6
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-3434
Mailing Address - Country:US
Mailing Address - Phone:713-542-0816
Mailing Address - Fax:
Practice Address - Street 1:1726 LAMPMAN DR
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-6494
Practice Address - Country:US
Practice Address - Phone:406-545-5106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-01
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LAC-LIC-4852101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)