Healthcare Provider Details

I. General information

NPI: 1235646787
Provider Name (Legal Business Name): CINDY ANN OLIVER LCPC, LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2018
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 LONE TREE LOOP
BOULDER MT
59632-7641
US

IV. Provider business mailing address

PO BOX 972
BOULDER MT
59632-0972
US

V. Phone/Fax

Practice location:
  • Phone: 406-498-5773
  • Fax: 406-422-4352
Mailing address:
  • Phone: 406-498-5773
  • Fax: 406-422-4352

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberBBH-LCPC-LIC-70412
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberBBH-LAC-LIC-1376
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: