Provider Demographics
NPI:1255468302
Name:PETAJA, MICHAEL ARTHUR (LCPC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ARTHUR
Last Name:PETAJA
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 PINECONE DRAW
Mailing Address - Street 2:
Mailing Address - City:CLANCY
Mailing Address - State:MT
Mailing Address - Zip Code:59634-9755
Mailing Address - Country:US
Mailing Address - Phone:406-461-0551
Mailing Address - Fax:406-442-6935
Practice Address - Street 1:1085 HELENA AVE
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-3558
Practice Address - Country:US
Practice Address - Phone:406-461-0551
Practice Address - Fax:406-442-6935
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1231-LCPC101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health