Individual
KIMBERLY WALLIS PANKO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA
Contact information
Practice address
7955 TOBY WAY, MISSOULA, MT 59808-5024
(406) 219-1302
Mailing address
2814 BROOKS ST STE 144, MISSOULA, MT 59801-7718
(406) 219-1302
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
BBH-LCPC-LIC-50086
MT
101YA0400X
Addiction (Substance Use Disorder) Counselor
4630
AK
101YM0800X
Mental Health Counselor
169890
AK
101YP2500X
Professional Counselor
Primary
BBH-LCPC-LIC-50086
MT
Other
Enumeration date
08/04/2020
Last updated
10/24/2024
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