Provider Demographics
NPI:1679344899
Name:KAVLIE, KAITLIN MICHELE (PCLC)
Entity type:Individual
Prefix:
First Name:KAITLIN
Middle Name:MICHELE
Last Name:KAVLIE
Suffix:
Gender:F
Credentials:PCLC
Other - Prefix:
Other - First Name:KAITLIN
Other - Middle Name:MICHELE
Other - Last Name:GOLDTHWAITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1018 N 30TH ST
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59101-0732
Mailing Address - Country:US
Mailing Address - Phone:406-252-4194
Mailing Address - Fax:
Practice Address - Street 1:1018 N 30TH ST
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-0732
Practice Address - Country:US
Practice Address - Phone:406-252-4194
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-PCLC-LIC-69832101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional