Provider Demographics
NPI:1609696822
Name:FREDERICK, BILL ALLEN (PCLC)
Entity type:Individual
Prefix:
First Name:BILL
Middle Name:ALLEN
Last Name:FREDERICK
Suffix:
Gender:M
Credentials:PCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 S 44TH ST W APT 10101
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59106-3988
Mailing Address - Country:US
Mailing Address - Phone:406-599-4440
Mailing Address - Fax:
Practice Address - Street 1:208 N BROADWAY STE 423
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-1943
Practice Address - Country:US
Practice Address - Phone:406-896-8427
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-14
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-PCLC-LIC-72757101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional