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Individual

MICHAEL WAYNE HETHERINGTON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
LCPC

Contact information

Practice address
4255 KIMBERWICKE ST, BOZEMAN, MT 59718-5700
(406) 522-6300
Mailing address
2472 LASSO AVE, BOZEMAN, MT 59718-8039
(406) 570-4692

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
BBH-LCPC-LIC-26162
MT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1477745370
MT
Enumeration date
12/14/2017
Last updated
01/24/2022
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