Provider Demographics
NPI:1366901266
Name:LODIEN, PHILIP
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:
Last Name:LODIEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 CEDAR COMMONS LN APT 3
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-5750
Mailing Address - Country:US
Mailing Address - Phone:406-270-8591
Mailing Address - Fax:
Practice Address - Street 1:723 5TH AVE. EAST
Practice Address - Street 2:ST. B18
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-5990
Practice Address - Country:US
Practice Address - Phone:406-253-1609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-19
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-PCLC-LIC-37322101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional