Healthcare Provider Details

I. General information

NPI: 1154446219
Provider Name (Legal Business Name): DONNA J DELICH LCSW LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 07/28/2020
Certification Date: 07/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 N MAIN ST STE 4
LIVINGSTON MT
59047-2000
US

IV. Provider business mailing address

320 N MAIN ST STE 4
LIVINGSTON MT
59047-2000
US

V. Phone/Fax

Practice location:
  • Phone: 406-223-3104
  • Fax: 406-333-2888
Mailing address:
  • Phone: 406-222-2812
  • Fax: 406-222-4764

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number792
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: