Individual
MISS PATRICE L MUDIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCPC
Contact information
Practice address
101 E BROADWAY ST STE 204, MISSOULA, MT 59802-4510
(406) 546-7761
Mailing address
225 CUMBERLAND ST, LOLO, MT 59847-9541
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
1153
MT
103TS0200X
School Psychologist
76159
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1538489380
—
MT
Enumeration date
06/03/2010
Last updated
06/21/2010
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