Provider Demographics
NPI:1952841843
Name:BASTA, MOLLY (LCPC)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:BASTA
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 69
Mailing Address - Street 2:
Mailing Address - City:BINGEN
Mailing Address - State:WA
Mailing Address - Zip Code:98605-0069
Mailing Address - Country:US
Mailing Address - Phone:406-813-1621
Mailing Address - Fax:
Practice Address - Street 1:337 1ST AVE E
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-4935
Practice Address - Country:US
Practice Address - Phone:406-813-1621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-27
Last Update Date:2025-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional