Healthcare Provider Details

I. General information

NPI: 1114688173
Provider Name (Legal Business Name): KIRSTEN K TOWNSEND LCPC, ACLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2022
Last Update Date: 10/22/2022
Certification Date: 10/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 S MAIN ST STE 10
CONRAD MT
59425-2532
US

IV. Provider business mailing address

415 S ILLINOIS ST
CONRAD MT
59425-2209
US

V. Phone/Fax

Practice location:
  • Phone: 815-858-4312
  • Fax: 406-466-3485
Mailing address:
  • Phone: 815-858-4312
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number54164
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number57592
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: