Healthcare Provider Details

I. General information

NPI: 1104316645
Provider Name (Legal Business Name): LYNDA S BEAUDRY LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2018
Last Update Date: 05/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 POPIMI STREET
BROWNING MT
59417-1289
US

IV. Provider business mailing address

P.O. BOX 1289
BROWNING MT
59417-1289
US

V. Phone/Fax

Practice location:
  • Phone: 406-338-3948
  • Fax: 406-338-2491
Mailing address:
  • Phone: 406-338-3948
  • Fax: 406-338-2491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number3425
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: