Provider Demographics
NPI:1871919944
Name:GROSSMAN, EMILY TUTVEDT (LCPC)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:TUTVEDT
Last Name:GROSSMAN
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:SARAH
Other - Last Name:TUTVEDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCPC
Mailing Address - Street 1:PO BOX 494
Mailing Address - Street 2:
Mailing Address - City:BELGRADE
Mailing Address - State:MT
Mailing Address - Zip Code:59714-0494
Mailing Address - Country:US
Mailing Address - Phone:406-518-1267
Mailing Address - Fax:
Practice Address - Street 1:699 FARMHOUSE LN
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-9402
Practice Address - Country:US
Practice Address - Phone:406-556-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-12
Last Update Date:2018-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT7698101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0000749440OtherBLUE CROSS-SHIELD OF MONTANA