Provider Demographics
NPI:1487127726
Name:PETT, KIRSTEN RENEE (LCSW)
Entity type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:RENEE
Last Name:PETT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KIRSTEN
Other - Middle Name:RENEE
Other - Last Name:HORN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:813 COTTONWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MT
Mailing Address - Zip Code:59044-2256
Mailing Address - Country:US
Mailing Address - Phone:406-671-0021
Mailing Address - Fax:
Practice Address - Street 1:3212 1ST AVE S
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-3814
Practice Address - Country:US
Practice Address - Phone:406-245-2751
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-09
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LCSW-LIC-367871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical