Provider Demographics
NPI:1780257717
Name:SMITH, TAMMIE SUE (LCPC)
Entity type:Individual
Prefix:MRS
First Name:TAMMIE
Middle Name:SUE
Last Name:SMITH
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:MISS
Other - First Name:TAMMIE
Other - Middle Name:SUE
Other - Last Name:SHELTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 907
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:MT
Mailing Address - Zip Code:59436-0907
Mailing Address - Country:US
Mailing Address - Phone:406-799-2711
Mailing Address - Fax:
Practice Address - Street 1:201 1ST AVE N
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:MT
Practice Address - Zip Code:59436-9245
Practice Address - Country:US
Practice Address - Phone:406-467-3447
Practice Address - Fax:406-467-3407
Is Sole Proprietor?:No
Enumeration Date:2021-07-19
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LCPC-LIC-43683101YP2500X, 101YM0800X
MT83382101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool