Healthcare Provider Details

I. General information

NPI: 1316933013
Provider Name (Legal Business Name): MARY F FITZPATRICK LCPC, LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 02/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1245 N 29TH ST
BILLINGS MT
59101-0122
US

IV. Provider business mailing address

1245 N 29TH ST
BILLINGS MT
59101-0122
US

V. Phone/Fax

Practice location:
  • Phone: 406-252-5658
  • Fax: 406-252-4641
Mailing address:
  • Phone: 406-252-5658
  • Fax: 406-252-4641

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1011
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number976
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: