Healthcare Provider Details

I. General information

NPI: 1235719980
Provider Name (Legal Business Name): KAREN LYNN DION LAC, NBC-HWC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2021
Last Update Date: 04/08/2021
Certification Date: 04/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 WULFF LN
LAKESIDE MT
59922-9643
US

IV. Provider business mailing address

PO BOX 991
LAKESIDE MT
59922-0991
US

V. Phone/Fax

Practice location:
  • Phone: 406-885-3849
  • Fax:
Mailing address:
  • Phone: 406-885-3849
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberBBH-LAC-LIC-2620
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number37552
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: