Healthcare Provider Details

I. General information

NPI: 1679944771
Provider Name (Legal Business Name): ASTRI MARIE ZIDACK LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2015
Last Update Date: 10/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 N 29TH ST
BILLINGS MT
59101-0905
US

IV. Provider business mailing address

PO BOX 35100
BILLINGS MT
59107-5100
US

V. Phone/Fax

Practice location:
  • Phone: 406-238-2500
  • Fax: 406-657-4945
Mailing address:
  • Phone: 406-238-2500
  • Fax: 406-657-4945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberSWP LCPC LIC 7403
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: