Healthcare Provider Details

I. General information

NPI: 1306697594
Provider Name (Legal Business Name): KRYSTI REICHMAN PCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2024
Last Update Date: 03/27/2024
Certification Date: 03/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 MAIN ST SE
RONAN MT
59864-2731
US

IV. Provider business mailing address

316 BUCHANAN ST SW
RONAN MT
59864-2615
US

V. Phone/Fax

Practice location:
  • Phone: 406-872-0630
  • Fax:
Mailing address:
  • Phone: 406-309-0082
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberBBH-PCLC-LIC-70450
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: