1902322266 NPI number — MS. TANYA L RICHEM MSC/ACLC, LCPC

Table of content: MS. TANYA L RICHEM MSC/ACLC, LCPC (NPI 1902322266)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902322266 NPI number — MS. TANYA L RICHEM MSC/ACLC, LCPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RICHEM
Provider First Name:
TANYA
Provider Middle Name:
L
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MSC/ACLC, LCPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1902322266
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1231
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHOTEAU
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59422-1231
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-590-7837
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1324 CENTRAL AVE W STE 6
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREAT FALLS
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59404-3971
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-590-7837
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/18/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  BBH-LCPC-LIC-25320 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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