Healthcare Provider Details

I. General information

NPI: 1023232634
Provider Name (Legal Business Name): LYNDA M FICHTNER LCSW, LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 01/01/2025
Certification Date: 01/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E BROADWAY ST STE 608
MISSOULA MT
59802-4597
US

IV. Provider business mailing address

101 E BROADWAY ST STE 608
MISSOULA MT
59802-4597
US

V. Phone/Fax

Practice location:
  • Phone: 406-360-1946
  • Fax:
Mailing address:
  • Phone: 406-360-1946
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLAC 1036
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW 683
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: