Healthcare Provider Details

I. General information

NPI: 1366566358
Provider Name (Legal Business Name): LASS MF DUDLEY LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARTHA FAIRCHILD DUDLEY LCPC

II. Dates (important events)

Enumeration Date: 03/17/2007
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3112 HOLMBERG DR
HELENA MT
59602-8511
US

IV. Provider business mailing address

3112 HOLMBERG DR
HELENA MT
59602-8511
US

V. Phone/Fax

Practice location:
  • Phone: 406-539-0300
  • Fax:
Mailing address:
  • Phone: 406-539-0300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1037
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: